Req ID: 61186BR
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.
Fundamental Components included but are not limited to:
Position will require travel in Northern NJ and a training period working out of the Princeton office. Applicants must be comfortable traveling to both.
The RN Case Manager is responsible for conducting face to face visits using comprehensive assessments of members enrolled in Managed Long-Term Services and Supports program (MLTSS). The care manager is responsible to coordinate and collaborate care with member/authorized representative, PCP, and any other care team participant. The RN care manager will attend interdisciplinary meetings and advocate on members behalf. The care manager works with member and care team to develop care plan and will authorize services within the MLTSS benefit. The care manager will also work with the member and care team to coordinate and assist with community resources. The care manager is responsible for documenting accurately and timely in the electronic health record. This position requires the care manager to use critical thinking and be able to problem solve any issues related to assigned membership. While this position is telework the care manager must work normal business hours.
Qualifications Requirements and Preferences:
3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home
health or ambulatory care,. ; Required
Active and Unrestricted RN in NJ ; Required
Case management or discharge planning experience or home health experience; Required
Managed Care experience; Preferred
Crisis intervention skills; Preferred
Field based Travel to meet with Members; Required
Nursing - Registered Nurse (RN)
Additional Job Information:
opportunity for telework after successful completion of training and leadership approval
Field based Travel to meet with Members required
Typical office working environment with productivity and quality expectations
Work 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 environment
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written.
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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