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RN Case Manager

Primary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix, CO-Denver, FL-Jacksonville, FL-Miami, FL-Orlando, FL-Tampa, GA-Atlanta, IA-Urbandale, MA-Burlington, MI-Detroit, MN-Minneapolis, MO-Kansas City, NC-Charlotte, ND-Bismarck, NE-Lincoln, NE-Omaha, NV-Las Vegas, NV-Reno, NY-East Syracuse, OH-New Albany, OK-Oklahoma City, OR-Portland, SC-Columbia, TX-Arlington, TX-Austin, TX-Dallas, TX-El Paso, TX-Houston, WV-Charleston
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Description:
Registered Nurse experience in field of case management with history in the field of managed care, or insurance preferred in addition to 5 years clinical background as an RN. Prefer candidates have a specialty background in Behavioral Health or Oncology as well as CCM and/or other URAC recognized certification. This position consists of working intensely as a case manager telephonically with patients and their care team for fully and/or self-funded clients.

This is a work-at-home/telework/telecommute Case Manager position that require 2 weeks of on-site training in the New Albany, Ohio office upon hire.

Fundamental Components:

Fundamental Components:
Enhancement of Medical Appropriateness and Quality of Care:
- Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits.
- Using a holistic approach consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives.
- Identifies and escalates quality of care issues through established channels.
- Ability to speak to medical and behavioral health professionals to influence appropriate member care.
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Incorporate the use of motivational interviewing with patients.
- Helps member actively and knowledgably participate with their provider in healthcare decision-making.
- Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
- Utilizes negotiation skills to secure appropriate options and services necessary.



Background Experience:

- Minimum of 5 years clinical practice experience, as an RN e.g., hospital setting, alternative care setting such as home health or previous Case Management experience required.
- Need to actively reach out and engage the patients.
- Requires ability to document electronically using keyboard and computer screens - free form text.
- Discharge planning experience preferred.
- Managed Care experience preferred

Education:
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

Licenses:
Active, unrestricted Registered Nurse (RN) license is required.
Nursing/Certified Case Manager (CCM) is preferred.

Telework Specifications:
Full-Time Telework (WAH)
Considered for any US location; 2 week training period in the New Albany, Ohio office is required



Additional Job Information:
Typical office working environment with productivity and quality expectations
Work 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 environment
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written.
Telephone etiquette.

Functional Skills:
Nursing - Case Management, Nursing - Concurrent Review/discharge planning, Nursing - Discharge Planning, Nursing - Medical-Surgical Care, Nursing - Oncology

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Education:
Nursing - Certified Case Manager (CCM), Nursing - Registered Nurse

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.

Click To Review Our Benefits (PDF)

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