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Aetna Workers Compensation RN Field Nurse Case Manager Registered Nurse in Orange, California

Req ID: 61650BR

Job Description

JOIN OUR GROWING TEAM

Are you tired of bedside nursing?

Are you looking to get away from 12-hour hospital shifts while continuing to utilize your RN expertise to impact the lives of patients in your local community?

We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Workers Compensation Field Case Management team. This opportunity offers a competitive salary, full benefits, and a performance-based bonus paid out on a monthly or quarterly basis. Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, and flexibility as you coordinate the care of your members.

Responsible for assessing and analyzing an injured employee to evaluate the medical and vocational needs required to facilitate the patient s appropriate and timely return to work. Acts as a liaison with patient/family, employer, provider(s), insurance companies, and healthcare personnel.

TERRITORY: Anaheim to Orange County, CA

Fundamental Components included but are not limited to:

Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, work-sites, or physician s office to provide ongoing case management services. Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. Prepares all required documentation of case work activities as appropriate. Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. Provides educational and prevention information for best medical outcomes. Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Testifies as required to substantiate any relevant case work or reports. Conducts an evaluation of members/clients needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member s/client s overall wellness through integration. Monitors member/client progress toward desired outcomes through assessment and evaluation.

All employees are expected to embody our values of Excellence, Integrity, Caring and Inspiration in all that they do as an employee. The overall responsibility of the Field Case Manager is to ensure the injured worker receives the best possible care in a timely and efficient manner towards full rehabilitation and return to work. Please note that we do offer mileage reimbursement for local travel.

As a Workers Compensation Field Case Manager, you will be offered:

Autonomy

Productivity incentives

Monday-Friday schedule

Reimbursement for mileage, tolls, parking, licensure and certification

Laptop, iPhone & printer/fax/scanner all in one.

All major holidays are paid time off, vacation and sick time off is accrued. Full benefits offered including 401(k) and many corporate discounts available. Employees are reimbursed for fees to maintain licensure as well as free CEU s to maintain licensure. Continuing Education credits are available/provided for RN and a various industry certifications too. Work from home with in-state travel. In addition to annual salary, position has potential for a monthly monetary bonus.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Qualifications Requirements and Preferences:

BACKGROUND/EXPERIENCE:

2+ years clinical practice experience.

2+ years case management experience with workers compensation, disability, and auto liability preferred.

If no case management experience, 5 years of Home Health Care and/or Hospice care.

Bilingual in Spanish preferred.

Knowledge of laws and regulations governing delivery of rehabilitation services.

Effective communications, organizational, and interpersonal skills.

Ability to work-independently, requires working from home in a safe and secure environment.

Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.

Effective computer skills including navigating multiple systems and keyboarding

EDUCATION

The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse (RN) is required

Prefer any of the following credentials in good standing: CCM, CDMS, COHN, COHN-S, CRRN.

FUNCTIONAL EXPERIENCES

Functional - Nursing/Case Management/1-3 Years

Functional - Nursing/Home Health Care/4-6 Years

Functional - Nursing/Occupational/1-3 Years

Functional - Nursing/Medical-Surgical Care/4-6 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User

Technical - Desktop Tools/Microsoft Word/4-6 Years/End User

Technical - Desktop Tools/Microsoft Explorer/4-6 Years/End User

Licenses/Certifications:

Nursing - Registered Nurse (RN)

Functional Skills:

Nursing - Critical Care

Additional Job Information:

High initiative, challenging position that utilizes critical thinking and effective communication skills while working with injured workers, employers, claims examiners, attorneys, and treatment providers to improve patient outcomes. Evaluates injured workers' medical and vocational needs to develop a specialized plan of care that promotes successful return to work while assisting in the coordination of therapeutic services. Monitors injured workers' progress toward desired outcomes in a variety of environments, including the home, work site, and physician office settings. Opportunity to make a positive impact in the life of an injured worker. Aetna benefits package.

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Healthcare

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

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