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Case Manager RN

Primary Location: Chicago, Illinois
Additional Locations: IL-Chicago, IL-Itasca, IL-Lincolnshire, IL-Rolling Meadows
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Description:

Develops,implements,supports, and promotesHealthServices strategies,tactics,policies, and programs thatdrive the delivery ofqualityhealthcaretoestablishcompetitivebusiness advantageforAetna.HealthServices strategies, policies, and programs are comprised ofutilizationmanagement,qualitymanagement,network managementand clinical coverage and policies.

Utilizesadvanced clinical judgmentand criticalthinking skills tofacilitateappropriate member physical healthand behavioral healthcarethroughassessmentand care planning,directprovider coordination/collaboration,and coordination ofpsychosocial wraparound services topromoteeffectiveutilizationofavailable resources and optimal,cost-effective outcomes.


There is a potential for work-at-home following a training period and proven productivity.


This position involves 50%-75% local field travel and requires a valid driver's license. The person in this role will support members in North/Northwest Chicago.



Fundamental Components:
AssessmentofMembers:
- Throughtheuse ofclinical toolsand information/datareview,conducts comprehensive assessmentsofreferred member’s needs/eligibilityand determinesapproach tocase resolutionand/ormeeting needs by evaluatingmember’s benefitplan and available internaland externalprograms/services.
- Appliesclinical judgmenttotheincorporationof strategiesdesigned toreduce risk factorsand address complex clinical indicatorswhich impactcare planning and resolution ofmember issues.
- Using advanced clinical skills,performscrisis interventionwithmembers experiencing a behavioral healthor medical crisis and refersthemtotheappropriateclinical providers forthoroughassessmentand treatment,as clinically indicated.Providescrisis followup tomembers tohelp ensure theyare receiving theappropriatetreatment/services.

EnhancementofMedical Appropriatenessand QualityofCare:
- Applicationand/orinterpretationofapplicable criteria and clinical guidelines,standardizedcase managementplans, policies,procedures,and regulatorystandardswhile assessing benefitsand/or member’s needs toensure appropriateadministrationofbenefits
- Using holisticapproach consultswithsupervisors,Medical Directorsand/orotherprograms toovercome barriers to meeting goals and objectives;presentscases at case conferencestoobtain multidisciplinaryview in order toachieve optimaloutcomes
-Identifiesand escalatesqualityofcare issues throughestablishedchannels.
- Ability to speak tomedical and behavioral healthprofessionalstoinfluenceappropriatemember care.
- Utilizesinfluencing/motivationalinterviewingskills toensure maximum member engagementand promotes lifestyle/behavior changes toachieve optimumlevel ofhealth.
- Providescoaching,informationand supporttoempower themember tomake ongoing independentmedical and/or healthylifestylechoices.
- Helps member activelyand knowledgeably participatewiththeirprovider in healthcaredecision-making
- Analyzesall utilization,self-reportand clinical dataavailable toconsolidateinformationand begin toidentify comprehensive member needs.

Monitoring,Evaluationand DocumentationofCare:
- In collaborationwiththemember and theircare teamdevelops and monitorsestablishedplans of care tomeetthemember’s goals.
- Utilizescase managementand qualitymanagementprocesses in compliance withregulatoryand accreditation guidelines and company policies and procedures.


Background Experience:

- Active and unrestricted State RN licensure required.

- 3+ years direct clinical practice experience required (e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility).

- Ability to multitask, prioritize and effectively adapt to a fast paced, changing environment required.

- Proficiency with computer skills required, which includes navigating multiple systems and keyboarding.

- Effective verbal and written communication skills required.

- Active IL driver's license required.

- Case Management and discharge planning experience preferred.

- Managed Care experience preferred.

- Utilization Review experience preferred.

- Crisis intervention skills preferred.

- Experience working with complex and/or behavioral health conditions preferred.



Additional Job Information:
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
Potential work at home with proven productivity
Ability to build daily schedule (during regular work hours)

Functional Skills:
Clinical / Medical - Disease management, Customer Service - Customer Service - Long Term Care, Medical Management - Medical Management - Case Management

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Education:
Nursing - Registered Nurse (RN)

Potential Telework Position:
Yes

Percent of Travel Required:
50 - 75%

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.

Click To Review Our Benefits (PDF)

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