Field Case ManagerPrimary Location: Chesterfield, Missouri
Additional Locations: MO-Chesterfield Apply
The Case Manager uses 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.
• Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as
• 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.
• Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their
homes, work-sites, or physician’s office to provide ongoing case management services. (*)
• Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a
plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical
outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
• 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. (*)
• Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health
• May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. (*)
• Provides educational and prevention information for best medical outcomes. (*)
• Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions
required by individual insurance carriers and referral sources. (*)
• Testifies as required to substantiate any relevant case work or reports. (*)
• Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using
clinical tools and information/data.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and 1
timely return to baseline, and optimal function or return to work.
• 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/client’s overall wellness through integration.
• Monitors member/client progress toward desired outcomes through assessment and evaluation. Background Experience:
• Minimum of three years’ case management experience (required for NCM role, preferred for all other areas).
• 5 years clinical practice experience (required for NCM role only).
• Ability to travel within a designated geographic area for in-person case management activities
• Bilingual preferred
• Knowledge of laws and regulations governing delivery of rehabilitation services.
• Job-specific technical knowledge, (e.g., knowledge of workers compensation and disability industry for workers’
compensation case managers or case management).
• Excellent analytical and problem solving skills
• Effective communications, organizational, and interpersonal skills.
• 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.
• Effective computer skills including navigating multiple systems and keyboarding
Education and Certification Requirements
• Registered Nurse with active state license in good standing in the state where job duties are performed is required
• Bachelor degree in a closely-related field, or an equivalent combination of formal education and recent, related
experience; preference will be given to applicants with a Master’s degree
• Certified Case Manager is preferred.
• Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required. Education: Nursing - Certified Case Manager (CCM) Potential Telework Position: Yes Percent of Travel Required: 10 - 25% 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.
Jobs for you
Recently Viewed Jobs
You do not have any recently viewed jobs
Your Saved Jobs
You do not have any saved jobs
Sign up for Job Alerts
Join our Talent Community
At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.
Join Our Talent Community
Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.