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Aetna is now a CVS Health Company

Consulting Case Manager

Primary Location: Doral, FL
Additional Locations: FL-Doral
Candidates must be located in or near the Broward County, FL area.

The Consulting Case Manager is responsible for internal and external-facing clinical activities with customers and providers that support a high-touch, patient-and-provider-centric focus. The Consulting Case Manager is responsible for using technology in-person and/or telephonically to assess members and develop a proactive course of action to holistically address the consumer’s issues.

Fundamental Components:
The Consulting Case Manager improves the provider and consumer experience by increasing healthy days through using technology, analysis, and a holistic approach to assess the needs of consumers by consulting and collaborating with other ACS and provider partners as well as vendor partners as part of a multidisciplinary approach to overcoming barriers in meeting goals and objectives to overall consumer health management. Facilitates the ongoing coordination of services as a member of a multidisciplinary team through the use of analytical thinking and information/data review, the Consulting Case Manager conducts an evaluation of member's needs and benefits plan eligibility and facilitates a smooth transition to Aetna/provider programs and plans.

The Consulting Case Manager also understands, through analysis, how each consumer fits into the broader population. The position requires applying and interpreting medical criteria and guidelines, applicable policies and procedures, regulatory standards, and all available benefit plan information to determine eligibility and integration with available internal and external programs while utilizing case management processes to ensure compliance with regulatory and company policies and procedures. Serves as an advisor by providing consultative interactions and serving as a clinical, business, and tech advocate to drive wellness for consumers and building relationships with providers by leveraging and applying external market trends and industry-relevant insights in care planning and management activities.

Background Experience:
RN licensure required
3+ years clinical experience required
3+ years case management experience required

Home health experience preferred
Managed care experience preferred
Bilingual in English and Spanish preferred

Additional Job Information:
Ability to multitask, prioritize and effectively adapt to a fast paced changing environmentWork requires the ability to perform close inspection of hand written and computer generated documents as well as mobile technology and a computer monitor.Relationship building requiring strong interpersonal skills. .Critical thinking skills, especially relating to comorbid conditions and social issues faced by consumers.Effective communication skills, both verbal and written.Position requires proficiency with technology, which includes navigating multiple systems and taking effective notes electronically.Ability to process and react to large amounts of information to generate an individualized plan of care that aligns with the provider plan of care.Ability to recognize and mobilize a variety of resources both within and outside the benefit plan to provide holistic care management including digital resources, financial resources, and community based resources.Travel within a designated geographic area is required for in-person case management activities, clinical case conferencing, clinical audits/call listening and clinical finalist presentations with customers and consultants. These activities will typically take place in member homes, provider offices, employer sites, or office locations.For the telephonic Consulting Case Manager role, if applicable, you must be able interact by telephone for extended periods of time at your desk and be able to talk and record notes simultaneously.Some Consulting Case Manager roles will require in-home member visits or visits to employers as an essential function of the job.

Potential Telework Position:

Percent of Travel Required:
50 - 75%

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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