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Clinical Case Manager RN

Primary Location: San Diego, CA
Additional Locations: CA-San Diego
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Description:
The Nurse Case Manager
(NCM) is responsible for telephonically and face-to-face assessing, planning,
implementing and coordinating all case management activities with members to
evaluate the physical and mental health needs of the member to facilitate the member’s
overall wellness. The NCM develops a proactive course of action to address
issues presented to enhance the short and long term outcomes as well as
opportunities to enhance a member’s overall wellness through integration of
services. Service strategies policies and programs are comprised of network
management and clinical coverage policies. Routine field based travel to member
locations 10-25% of the time is required using a personal vehicle. Qualified
candidates must have dependable transportation, valid and active CA driver's
license and proof of vehicle insurance.




Fundamental Components:
  • Through the use of
    clinical tools, information, data review, conducts an evaluation of member's
    needs and benefit plan eligibility.
  • Facilitates integrative functions as well
    as smooth transition to Aetna and respective California program, e.g. Health
    Homes.
  • Assessments take into account information from various sources to
    address conditions including co-morbid and multiple diagnoses that impact
    functionality and serves as a clinical resource for the member.
  • Advocates on
    behalf of members with health care professionals and offers services where the
    member lives, seeks care, or finds most easily accessible and within
    guidelines.
  • Facilitates access to primary care and behavioral health providers
    as needed.
  • Reviews prior claims to address potential impact on current case
    management and eligibility.
  • Using holistic approach assess the need for a
    referral to clinical and supportive resources for assistance.
  • Consults with
    supervisor and others to overcome barriers to meet goals and objectives,
    presents at case conferences for multidisciplinary focus to benefit overall
    management.


Background Experience:


Required Qualifications of the RN Case Manager:
3+ years of clinical practice experience, preferably home health, hospital, ambulatory care

Computer literacy and proficiency with Microsoft Excel, Word, including navigating multiple systems and keyboarding

Ability to multitask, prioritize and effectively adapt to a fast paced changing environment

Familiarity with local health care delivery systems and community resources Behavioral Health experience is a plus

Strong documentation, organization, and Communication skills Ability to work independently and as part of a team

Preferred Qualifications of the RN Case Manager:

Case management and discharge planning is strongly preferred

Managed care experience is strongly preferred Crisis intervention skills Bilingual-Spanish speaking skills are a plus

Previous experience conducting face-to-face care management




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.
This San Diego or
Sacramento position is eligible for telework. Training will be provided in the
respective office location based on position being hired. Commencement of
telework to be determined; typically after one year in the position and/or
following successful completion of training and demonstrated performance with
assigned case load. The position also requires routine field based travel
50-75% of the time, in San Diego or Sacramento depending on field placement of
position.


Education:
Nursing - Registered Nurse

Potential Telework Position:
No

Percent of Travel Required:
10 - 25%

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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