Case ManagerPrimary Location: New Albany, OH
Additional Locations: OH-New Albany Apply
The Care Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. The CM process includes: assessing the member's health status and care coordination needs, inpatient review and discharge planning, developing and implementing the CM plan, monitoring and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria.
The responsibilities of this position are to apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs. Conducts comprehensive clinical assessments. Evaluates needs and develops flexible approaches based on member needs, benefit plans or external programs/services. Advocates for patients to the full extent of existing health care coverage. Promotes quality, cost effective outcomes and makes suggestions to improve program/operational efficiency. Identifies and escalates quality of care issues through established channels. Expectation is a very high level of customer service.
|Fundamental components related to the Aetna One Premier program include but are not limited to; Utilizes assessment techniques to determine member’s level of health literacy, technology capabilities, and/or readiness to change. Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. Provides coaching, information, education and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.|
3+ years clinical experience required
Case 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 - Supporting Medical Practice, Benefits Management - Understanding Clinical Impacts, Leadership - Collaborating for Results Desired Skills: Benefits Management - Maximizing Healthcare Quality, Finance - Managing Aetnas Risk, Service - Providing Solutions to Constituent Needs Functional Skills: Nursing - Case Management, Nursing - Clinical coverage and policies, Nursing - Concurrent Review/discharge planning, Nursing - Medical-Surgical Care Technology Experience: Aetna Application - Aetna Strategic Desktop Reporting, Aetna Application - Aetna Total clinical View, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word Education: Nursing - Certified Case Manager, 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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