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Aetna Case Manager RN in Phoenix, Arizona

Req ID: 61489BR

Job Description

This is a work at home (telework) position that will require in field travel within the central Phoenix, AZ area

POSITION SUMMARY

This Case Manager - RN role will strive to positively influence the practices overall patient health outcomes through achieving favorable patient outcomes measured by clinical quality and utilization measures.

With a focus on delivering comprehensive, patient-centered care across the health care continuum, the case manager will work closely with physician practices to deliver daily care coordination, chronic care management, coaching, consultation and intervention with a particular focus on patients with complex health care needs.

#LT-TS1

Fundamental Components included but are not limited to:

Fundamental Components:

  • Leveraging technology, and working closely as part of a provider, interdisciplinary care team, the case manager will identify complex, high-risk patients and proactively manage care including but not limited to care management planning, referral management, post-discharge planning, and coordinating transitional and community based care.

  • Through the use of a clinical decision support system, the patient population will be monitored and managed, including the identification and risk stratification of complex, co-morbid patients, with the objective of focusing case management efforts on the segment of the population requiring the highest degree of support.

  • Provide a patient-centered, interdisciplinary approach to health care and care coordination using comprehensive, evidenced-based care plans developed in concert with the patient/care giver and with the support of the provider.

  • Cultivates a strong, cohesive, team-oriented relationship with practice partners, including on-site and remote interaction where appropriate, whereby the practices care team considers the case manager as an extension of and integral part of the practices care delivery program.

  • Screens patients and conducts individualized clinical assessments of patients health concerns/needs; support the patient in developing personalized condition-specific action plans, provides appropriate education, monitoring and appropriate care management program referrals.

  • Evaluates the patients progress in setting and meeting established goals and revises their individualized care plan accordingly. As appropriate, performs transitions in care assessments for patients discharged from an in-patient hospital or skilled nursing facility.

  • Medication reconciliation in supporting patient medication management, particularly as it relates to the post-discharge planning process in support of medication compliance, and treatment adherence.

  • Advocates, guides and intervenes on behalf of patients, their family and/or care givers, in concert with the PCP, in understanding and navigating the health care system, including the coordination of community resources.

  • Defines, evaluates and reports on desired and actual patient health outcomes in collaboration with the interdisciplinary care team. In urgent and non-emergency situations, facilitates the escalation of high-priority, problem patient cases that require direct and/or immediate intervention by the physician care team.

  • Provides crisis follow up

Qualifications Requirements and Preferences:

BACKGROUND/EXPERIENCE:

Active and unrestricted Nursing/Registered Nurse (RN) License required

Minimum 3 years of current clinical experience in a patient case management position such as CM, DM case worker, and other relevant roles required

Strong professional level knowledge of comprehensive clinical assessment skills in the adult population and experience with chronic disease management preferred

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

Nursing/Certified Case Manager (CCM) is preferred

Licenses/Certifications:

Nursing - Registered Nurse (RN)

Additional Job Information:

Typical office working environment with productivity and quality expectationsWork requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.Ability to multitask, prioritize and effectively adapt to a fast paced changing environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective communication skills, both verbal and written.

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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