Case Manager RNPrimary Location: Blue Bell, PA
Additional Locations: CA-Fresno, CO-Denver, FL-Coral Gables, PA-Blue Bell, TX-Austin Apply
Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the transplant member's needs and to facilitate the member’s overall wellbeing. In doing this the NCM 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. Nurse Case Manager is also responsible for completing utilization reviews on members enrolled in Transplant Case Management. Services strategies policies and programs are comprised of network management and clinical coverage policies
66375Fundamental Components: 80% of activities focused on Transplant Case Management;
Interacts with the Provider and Member to achieve optimal outcomes within the benefit plan;
Collaborates with the NME Medical Director for benefit plan guidance and medical determinations;
Manages all aspects of the Transplant member’s care including non-transplant related
services to include Utilization Management;
Works with the claims examiner to administer accurate payment per the benefit plan;
Involves Network for LOAs and contracting negotiations/needs Background Experience: RN with current unrestricted state licensure required.
Ability to obtain additional RN state licenses required.
5+ years clinical experience required
Case management experience preferred
Transplant and /or critical care experience preferred
Utilization review experience preferred
Computer literate, skilled with Excel, Word and research utilizing the internet
Compact RN License a plus; California licensed RN residing in California a plus Additional Job Information: 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. Required Skills: Benefits Management - Understanding Clinical Impacts, General Business - Consulting for Solutions, Leadership - Collaborating for Results Desired Skills: Benefits Management - Maximizing Healthcare Quality, Leadership - Driving a Culture of Compliance, Technology - Leveraging Technology Functional Skills: Nursing - Case Management, Nursing - Concurrent Review/discharge planning, Nursing - Critical Care Education: Nursing - Registered Nurse Potential Telework Position: Yes Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: Aetna takes our candidate'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.
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