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Workers' Comp Telephonic Case Manager

Primary Location: Columbia, Missouri
Additional Locations: AR-Little Rock, AZ-Tucson, CO-Denver, DE-Newark, FL-Tallahassee, GA-Atlanta, IA-Cedar Rapids, ID-Boise, KY-Lexington, ME-Portland, MO-Columbia, MS-Ridgeland, NC-Raleigh, NE-Lincoln, NM-Albuquerque, OK-Oklahoma City, SC-Greenville, TN-Memphis, TX-El Paso
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Description:
Responsible for telephonically assessing, planning, implementing and coordinating all case management activities associated with an injured employee to evaluate the medical and disability needs of an injured worker and facilitate the patient’s appropriate medical care.

Fundamental Components:
Works telephonically with workers’ compensation patients, employers, providers, and claims adjusters to coordinate and assure proper delivery and oversight of medical and disability services. Performs pre-certification process for prescribed treatment by gathering relevant data and information through clinical interviews with the injured employee, provider(s), and the employer. Evaluates and coordinates medical and rehabilitative services using cost containment strategies. Plans a proactive course of action to address issues presented to enhance the injured employee’s short and long-term outcomes. Assesses and identifies barriers to recovery; determines goals, objectives, and potential alternatives to care. Works as an advocate to promote the injured employee’s best interest, addressing treatment alternatives, coordination of quality, cost effective health care and rehabilitative services. Assists the injured employee by providing medical and disability education and coordinating on-site job analysis, work conditioning, functional capacities, and ergonomic evaluations. Negotiates and assists employers with the development of transitional sedentary or modified job duties based on the injured employee’s functional capacity to ensure the injured employee’s safe and timely return to work. Monitors, evaluates, and documents case management activities and outcomes including, but not limited to, case management approaches, over or under utilization, inappropriate care, effective treatment, permanent or temporary loss of function, failed or premature return to work, and non-compliance. Adheres to all appropriate privacy, security and confidentiality policies and procedures. Performs other duties as assigned.

Background Experience:

An active and good standing compact state RN license is required.

Minimum of 3 years clinical practice experience required.

- 1+ year of case management experience is required.

- Strong analytical skills used to identify and resolve problems required.

- Willingness to obtain an RN license for California is required.
- Previous workers compensation, utilization review or managed care experience preferred.
- Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) preferred, but not required.
- Effective communications, organizational, and interpersonal skills required.
- Bachelor's degree in a closely-related field, or equivalent combination of education and experience.

- Bilingual in English and Spanish is preferred, but not required.



Functional Skills:
Nursing - Case Management

Education:
Nursing - Registered Nurse (RN)

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.

Click To Review Our Benefits (PDF)

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