Bilingual Case Manager RNPrimary Location: Sunrise, Florida
Additional Locations: FL-Sunrise Apply
Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case
management activities with members to evaluate the medical and disability needs of the member to facilitate the
members overall wellness and appropriate and timely return to work. In doing this 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
members overall wellness through integration. Services strategies policies and programs are comprised of network
management and clinical coverage policies.
Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit
plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
Assessments will 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.
Assessments will include the members level of work capacity and related restrictions/limitations.
Application and interpretation of disability criteria and guidelines, applicable policies and procedures, regulatory
standards and disability benefit plan to determine eligibility and integration with available internal/external programs.
Using 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.
Supports, integrates and executes the IHD process.
Utilizes assessment techniques to assess for integration opportunities and determining work capacity.
Utilizes l interviewing skills to ensure maximum member engagement in disability process and a timely RTW.
3+ years clinical practice experience (Case Management or Acute Care)
Bilingual Spanish Required
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, 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 a PC
Typical office working environment with productivity and quality expectations
Case management experience preferred
Managed Care experience preferred
Discharge planning experience preferred
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is REQUIRED
Technical - Computer Operations//1+ Years/
This position will be in office and will require 25% travel to member homes, provider offices, and/or hospitals
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidates'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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