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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Case Manager RN

Primary Location: Dallas, TX
Additional Locations: TX-Dallas
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Description:
Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

#LT-TS1

Fundamental 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. . 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.




This position involves telephonic case management with face to face visits in a fast paced, production environment.

The Clinical Case Manager will:

-both outreach and receive calls from members

-educate members on their disease processes

-educate members on preventative care and wellness

-collaborate care with providers -assist members with all of their needs






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:

Aetna is about more than
just doing a job. This is our opportunity to re-shape healthcare for America
and across the globe. We are developing solutions to improve the quality and
affordability of healthcare. What we do will benefit generations to come. We
care about each other, our customers and our communities. We are inspired to
make a difference, and we are committed to integrity and excellence. Together
we will empower people to live healthier lives. Aetna is an equal opportunity
& affirmative action employer. All qualified applicants will receive
consideration for employment regardless of personal characteristics or status.
We take affirmative action to recruit, select and develop women, people of
color, veterans and individuals with disabilities. We are a company built on
excellence. We have a culture that values growth, achievement and diversity and
a workplace where your voice can be heard.


Typical office working environment with productivity and quality expectations. 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 - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts

Desired Skills:
General Business - Applying Reasoned Judgment, Leadership - Driving a Culture of Compliance, Sales - Negotiating Collaboratively

Functional Skills:
Nursing - Case Management, Nursing - Medical-Surgical Care, Nursing - Neonatal Intensive Care, Nursing - Pediatrics

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

Education:
Nursing - Certified Case Manager (CCM), Nursing - Registered Nurse (RN)

Potential Telework Position:
No

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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