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
Case Manager RN Registered Nurse Wayne County Detroit, Michigan East side Some Detroit Michigan West SidePrimary Location: Detroit, Michigan
Additional Locations: MI-Detroit Apply
Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical and disability needs of the member to facilitate the members overall wellness and appropriate and timely return to work. In doing this the NCM develops a proactive course of action to address issues presented to enhance the short and long term outcomes as well as opportunities to enhance a members overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.
Standard Business Hours.
Territory Wayne County Detroit, Michigan, East side some Detroit Michigan West Side.
Fundamental Components but not limited to the following:
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 Assessments will 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 will include the members level of work capacity and related restrictions/limitations.Application and interpretation of disability criteria and guidelines, applicable policies and procedures, regulatory standards and disability benefit plan to determine eligibility and integration with available internal/external programs. Using 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 Utilize case management processes in compliance with regulatory and company policies and procedures.
2+ years clinical practice experience
2+ years of Home Health experience
2+ years utilizing Microsoft (Outlook, Word, Excel and Power Point)
The minimum level of education for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse active and unrestricted in the State of Michigan is required
Functional - Nursing/Home Health Care Ambulatory Nursing/1-3 Years
Functional - Nursing/Case Management/1-3 Years
Functional - Medical Management/Medical Management - Case Management/1-3 Years
Functional - Nursing/Discharge Planning/1-3 Years
Functional - Nursing/Disease management/1-3 Years
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Exchange/4-6 Years/End User
Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User
Technical - Desktop Tools/Video Conferencing/1-3 Years/End User
Benefits Management/Understanding Clinical Impacts/FOUNDATION
Benefits Management/Supporting Medical Practice/FOUNDATION
General Business/Applying Reasoned Judgment/ADVANCED
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.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidates'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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