Aetna Case Manager RN in San Antonio, Texas

Req ID: 56521BR

POSITION SUMMARY

This is an in-office position in San Antonio, TX.

Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical and disability needs of the member to facilitate the member's overall wellness and appropriate and timely return to work. In doing this, the case manager 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 overall wellness through integration. Services, strategies, policies and programs are comprised of network management and clinical coverage policies.

Fundamental Components:

Utilizes assessment and interviewing skills to ensure maximum member engagement. Collaboration skills. Utilizes clinical tools and information/data to review and conduct an evaluation of member's needs and benefit Plan eligibility & facilitates integrative functions as well as smooth transition to alternate Level of Care settings. Utilizes case management processes in compliance with regulatory and company policies and practices.

BACKGROUND/EXPERIENCE:

RN licensure required

5+ years clinical experience required

Case management experience preferred

Managed care experience preferred

Call center experience preferred

Bilingual preferred

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is required

FUNCTIONAL EXPERIENCES

Functional - Nursing/Case Management/1+ Years

Functional - Nursing/Discharge Planning/1+ Years

Functional - Nursing/Disease management/1+ Years

Functional - Nursing/Clinical coverage and policies/1+ Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Explorer/4+ Years/Power User

Technical - Desktop Tools/Microsoft Outlook/4+ Years/Power User

Technical - Desktop Tools/Microsoft Word/4+ Years/Power User

REQUIRED SKILLS

Leadership/Collaborating for Results/ADVANCED

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Understanding Clinical Impacts/FOUNDATION

DESIRED SKILLS

Leadership/Driving a Culture of Compliance/FOUNDATION

Service/Providing Solutions to Constituent Needs/ADVANCED

ADDITIONAL JOB INFORMATION

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

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

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care

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.