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RN Clinical Case Manager

Primary Location: Norfolk, VA
Additional Locations: VA-Norfolk
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Description:
The Clinical Care Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members through assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes. Please note that this position will require routine and frequent field-based travel to member locations.

Traveling in the field (homes or providers) 25-50% local travel.

Schedule Monday-Friday business hours, no holidays and no weekends.

Territory Chesapeake, Virginia Beach and Norfolk, VA area.


Fundamental Components:
Assessment of Members:
- Through the use of clinical tools and review of member specific health information/data, conducts comprehensive assessments of referred members needs/eligibility and, in collaboration with the members care team, determines an approach to resolving member issues and/or meeting needs by evaluating the members benefit plan and available internal and external programs/services and resources.
- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex clinical indicators which impact care planning and resolution of member issues.
- Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical and service providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
- Enhancement of Medical Appropriateness and Quality of Care
- Monitoring, Evaluation and Documentation of Care

Background Experience:
- 3 years of clinical practice experience (hospital setting, alternative care setting such as home health, or ambulatory care, acute and hospital) required.
- Managed care experience preferred
- Must have the ability to support the complexity of members' needs, including face-to-face visitation.
- Proficiency with Microsoft Excel, Word, navigating multiple systems and keyboarding required.
- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment required.
- Strong documentation skills required.
- Ability to work both independently and as part of a team required.
- Strong written and verbal communication skills required.
- Strong organizational skills required.
- Ability to travel in the field required (25-50% local field travel).
- Bilingual preferred

LICENSE

- RN (unrestricted & active VA state license)

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:
Technology - Leveraging Technology

Functional Skills:
Medical Management - Medical Management - Managed Care/Insurance Clinical Staff, Nursing - Case Management, Nursing - Discharge Planning

Technology Experience:
Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook

Education:
Nursing - Registered Nurse

Potential Telework Position:
Yes

Percent of Travel Required:
25 - 50%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by 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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