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)Primary Location: High Point, North Carolina
Additional Locations: NC-High Point Apply
This role is office based in High Point, NC.
Hours are Monday-Friday 8am-4:30pm with evening shift rotation until 8pm approximately once per week.
The Clinical Services Advocate is part of a dedicated team of clinical and service professionals empowered to take care of all aspects of a members health. Clinical Services Advocates are responsible for providing personalized, end to end member support including coordination of health care services, decision support, benefits support, complex case management and chronic condition management. Clinical Service Advocates serve as a single point of contact to help the provider, member and family maximize benefits and easily navigate the health care system. The Clinical Advocate provides the member and provider community with a powerful and proactive experience through high touch, personalized communications designed to help the member achieve their health ambition in collaboration with the provider
62848Fundamental Components: Facilitate the ongoing coordination and delivery of health care services to enhance a members health, wellness and achieve quality outcomes. Effectively engage members and providers using omni-channel communication mechanisms (phone, email, chat, text, IM). Develop a personalized plan with member based on their health ambition and communication preferences. Integrate and collaborate with the other members of the core clinical and service team to support the single point of contact design for the member and enrolled family. Assist with effective use of health care benefits, access to available programs/services and determining next best actions to achieve health ambitions. Conduct proactive outreach to at risk members and leverage available data to identify actionable health needs. Holistically assess members needs and collaborate with treating providers, vendor partners and other Advocate team members to formulate care plans and coordinate services. Participate in the development of personalized, creative solutions to help members meet their health care needs. Assist members to prioritize health goals to achieve positive outcomes and health ambitions. Build strong, trusting relationships by fully understanding the members needs and goals Background Experience: -RN with current, unrestricted licensure in state in which work is being done required
-Willingness to obtain RN licensure in other states as needed required
-3+ years of clinical experience is required
-Experience in case management, precertification, and/or discharge planning 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 - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, Benefits Management - Promoting Health Information Technology Desired Skills: Benefits Management - Maximizing Healthcare Quality, Benefits Management - Supporting Medical Practice, Benefits Management - Understanding Clinical Impacts Functional Skills: Clinical / Medical - Direct patient care (hospital, private practice), Nursing - Case Management, Nursing - Discharge Planning Technology Experience: Aetna Application - Aetna Strategic Desktop Reporting, Aetna Application - Aetna Total clinical View, Desktop Tool - Microsoft Outlook 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 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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