Clinical Case Manager BH/RNPrimary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix Apply
Nurse/ Behavioral Health Care/Case Manager is responsible for working with the assigned behavioral health PNO and addressing high utilizing members for gaps in care. Care managers work with PNO clinic staff on members as well as external PCP's, specialists, DME companies on bringing together medical and behavioral health in all aspects.
64683Fundamental Components: Through the use of clinical tools and information/data review, conducts an evaluation of member's needs. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex medical health, behavioral health and social indicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on ke Background Experience: -RN with current unrestricted state licensure required
-Case/Care Management in an integrated model preferred
-3+ years clinical practice experience required
-Behavioral health 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. Desired Skills: General Business - Communicating for Impact, General Business - Consulting for Solutions Functional Skills: Clinical / Medical - Disease management, Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Disease management Technology Experience: Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel Education: Mental Health - Licensed Clinical Social Worker, Mental Health - Licensed Professional Counselor, 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.
Jobs for you
Recently Viewed Jobs
You do not have any recently viewed jobs
Your Saved Jobs
You do not have any saved jobs
Sign up for Job Alerts
Join our Talent Community
At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.Sign Up
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.