Aetna Registered Nurse (RN) Case Manager in Tampa, Florida

Req ID: 56717BR

POSITION SUMMARY

This Registered Nurse position consists of working intensely as a case manager with patients and their care team. Looking for a flexible, passionate patient advocate to work with a new program at a client site in Tampa, FL. Needs to be able to help steer patients forward to their best healthy outcomes.

There is a required 2-week on-site training in New Albany, OH beginning on the first day of employment.

Fundamental Components:

Enhancement of Medical Appropriateness and Quality of Care:

  • Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits.

  • Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives.

  • Identifies and escalates quality of care issues through established channels.

  • Speaks to medical and behavioral health professionals to influence appropriate member care.

  • Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Incorporates the use of motivational interviewing with patients.

  • Helps member actively and knowledgably participate with their provider in healthcare decision-making.

  • Actively reaches out and engages patients.

  • Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.

  • Utilizes negotiation skills to secure appropriate options and services necessary.

Qualification Requirements and Preferences:

  • 5+ years clinical practice experience as an RN (e.g., hospital setting, alternative care setting such as home health or previous case management experience) required.

  • Active and unrestricted RN license for State of FL required.

  • Ability to document electronically using keyboard and computer screens required.

  • Ability to work in multiple systems and coordinate with team members required.

  • Discharge planning and/or case management experience preferred.

  • Managed Care experience preferred.

Education:

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

Licenses and Certifications:

  • Active and unrestricted Registered Nurse (RN) license for the state of FL required.

  • Certified Case Manager (CCM) or other URAC recognized certification preferred.

FUNCTIONAL EXPERIENCES

Functional - Nursing/Case Management/1-3 Years

Functional - Nursing/Discharge Planning/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Understanding Clinical Impacts/FOUNDATION

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.

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.