At Aetna, we’re pioneering a total approach to health and wellness, focusing on the whole person - body, mind, and spirit. Our more than 4,000 nurses are central to turning our member’s health ambitions, big and small, into achievements. Your role will include helping members stay well, manage health conditions, and access the right care at the right time. As you do this, we’ll support you in achieving more in your life and your work.
What makes a successful nurse? Here are the traits we are looking for:
- Problem Solver
- Results Driven
- Technology Savvy
- Detail Oriented
- Good Listener
- Open Minded
- Team Player
Paid Time Off & Disability
Care Manager Registered NursePrimary Location: Dallas, Texas
Additional Locations: TX-Dallas Apply
65410Fundamental Components: Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. Background Experience: - 3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care; Required
- Pediatric, Mother/Baby, Labor and Delivery, or Neo-Natal experience; Preferred
- Case management and discharge planning experience; Preferred
- Managed Care experience; Preferred
- Crisis intervention skills; Preferred
- Good organizational skills, computer skills, and excellent Customer Service skills ; Required
- Bilingual Spanish Fluency; Preferred 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. Good organizational skills. Required Skills: Benefits Management - Promoting Health Information Technology, General Business - Communicating for Impact, Service - Providing Solutions to Constituent Needs Desired Skills: Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality Functional Skills: Customer Service - Customer Service - Outbound calls - survey administration, Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Disease management Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word Education: Nursing - Certified Case Manager (CCM), Nursing - Certified Low Risk Neonatal Nurse, Nursing - Certified Medical Surgical Nurse, Nursing - Certified Pediatric Nurse, Nursing - Registered Nurse (RN) Potential Telework Position: No 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.
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