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LPN Health Advocate Hi Tech/Hospitality

Primary Location: Fresno, CA
Additional Locations: CA-Fresno
Office-based position in Fresno, CA.

Utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration. This position will support the HiTech and Hospitality teams and do outreach to member or take inbound calls from members to assist them in getting connected to the proper resources for their health care concerns. Will do proactive outreach on high cost claimants, PCP under utilization, Freq ER utilization members to educate them on the resources available to them through the care management team as well as help them find par providers. . Requires LPN/LVN with unrestricted active license. (NOTE: IF required to obtain licensure in all states. Aetna will provide support to do so.) This is an exciting opportunity to grow with new and innovative care management team and use your clinical skills to aid those in need.

Fundamental Components:
Promotes/supports quality effectiveness of Healthcare Services and benefit utilization Utilizes clinical skills to support coordination, documentation and communication of medical services and/or benefit administration Collects information to support the process of identifying members for referral opportunities to integrate with other products, services and/or programs Utilizes clinical experience to guide patients to the proper resources on the team.

Background Experience:
LPN/LVN required
3+ years clinical experience required

Utilization management experience preferred
Managed care experience preferred.

Additional Job Information:
Typical office working environment with productivity and quality expectationsWork 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 environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective 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 - Communicating for Impact, Leadership - Collaborating for Results, Service - Handling Service Challenges

Functional Skills:
Administration / Operation - Data Entry, Clinical / Medical - Direct patient care (hospital, private practice), Customer Service - Customer Service - Member Services - Traditional products, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff

Technology Experience:
Aetna Application - Aetna Total clinical View, Aetna Application - TE Aetna Strategic Desktop, Desktop Tool - Microsoft Outlook

Potential Telework Position:

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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