Monday , May 27 2024

Aetna Careers – Nurse Case Manager

Website Aetna

Job Description:

Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.

Job Responsibilities:

  • Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services.
  • 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.
  • 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.
  • 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.
  • Provides educational and prevention information for best medical outcomes.

Job Requirements:

  • Ability to work independently (may require working from home).
  • Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
  • Efficient and Effective computer skills including navigating multiple systems and keyboarding
  • Certified Case Manager is preferred.
  • Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required
  • Registered Nurse with active state license in good standing within the region where job duties are performed is required.
  • Excellent analytical and problem-solving skills
  • Effective communications, organizational, and interpersonal skills.

Job Details:

Company: Aetna

Vacancy Type: Full Time

Job Location: Baton Rouge, LA, US

Application Deadline: N/A

Apply Here

vacanciesforyou.xyz