Telephonic Case ManagerPrimary Location: Dallas, Texas
Additional Locations: TX-Dallas Apply
This role sits on-site in Dallas, TX.
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 and timely return to work. Acts as a liaison with patient/family, employer, provider(s), insurance companies, and healthcare personnel.
61953Fundamental 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:
-Registered Nurse (RN) with active TX state license in good standing required and ability to obtain additional state licenses as requested.
-Minimum of 2 years clinical practice experience required.
-1.5+ years of previous workers compensation case management experience preferred
-Strong analytical skills used to identify and resolve problems required.
-Previous utilization review experience preferred.
-Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) required or eligible to test within first year of employment
-Effective communications, organizational, and interpersonal skills required.
Additional Job Information
This job will be working onsite in the customer's claim office, interacting daily with claims examiners in collaborative efforts to progress injured workers towards return to work and medical recovery.Required Skills: Benefits Management - Interacting with Medical Professionals, Benefits Management - Understanding Clinical Impacts Desired Skills: Sales - Negotiating Collaboratively, Service - Handling Service Challenges, Service - Providing Solutions to Constituent Needs Functional Skills: Medical Management - Medical Management - Case Management, Nursing - Case Management, Nursing - Disability, Nursing - Medical-Surgical Care Technology Experience: Desktop Tool - Microsoft Explorer, Operating System - Windows Education: Nursing - Registered Nurse 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
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