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: Phoenix, Arizona
Additional Locations: AZ-Phoenix Apply
Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all transplant related case management activities with members to evaluate the medical needs of the member to facilitate the transplant process. Develops a proactive course of action to address issues presented to enhance the transplant process. Services strategies policies and programs are comprised of network management and clinical coverage policies.
66562Fundamental Components: -The role of a Transplant Case Manager encompasses key functions of a Utilization and a Case Manager.
-Transplant Case Manager utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for transplant members.
-Gathers clinical information and applies the appropriate clinical criteria/guideline, benefits limitations, and clinical judgment to render coverage determination/recommendation along the continuum of care.
-Authorizes medically necessary services, prepares cases for Medical Director review, and reviews claims for correctness. Communicates with providers and other parties to facilitate care/treatment.
-Identifies members for referral opportunities to integrate with other products, services, and programs.
-Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization while considering cost-effectiveness.
-Consults and lends expertise to other internal and external constituents in the coordination and administration of the prior authorization/benefit management function Background Experience: -RN with current unrestricted state licensure required
-3+ years clinical practice experience required
-Case Management experience preferred
Additional Job Information: Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. Sedentary work involving periods of sitting, talking and listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Work requires the ability to perform close inspection of hand written and computer generated documents as well as the PC monitor. Typical office working environment with productivity and quality expectations. Required Skills: Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, Benefits Management - Understanding Clinical Impacts Desired Skills: Benefits Management - Maximizing Healthcare Quality, Benefits Management - Promoting Health Information Technology, Benefits Management - Shaping the Healthcare System Functional Skills: Nursing - Case Management, Nursing - Clinical coverage and policies, Nursing - Disease management, Nursing - Medical-Surgical Care Technology Experience: Aetna Application - Milliman, Database - Intuit QuickBase, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word Education: Nursing - Registered Nurse, Nursing - Registered Nurse (RN) Potential Telework Position: Yes 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.
Health hero Q&A
This Aetna nurse helps new moms overcome opioids.
2018 Most Admired
Aetna named one of Fortune's most admired companies
Sign up for Job Alerts
Explore This Area
Check out where you could be working if you apply.View Map
Join Our Talent Community
Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.