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Must be located in CA and have a California RN license. Will consider candidates who live in commuting distance to an Aetna CA office. If current Aetna telework employee, can remain working from home. If new Aetna employee, there is the potential to work from home after training and proven performance.POSITION SUMMARYThe Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN with unrestricted active license. The CM process includes: assessing the member's health status and care coordination needs, in-patient review and discharge planning, developing and implementing the CM plan, monitoring and evaluating the plan, involving the MD (Medical Director) as indicated, and closing the case as appropriate when the member has met discharge criteria.Ideal Candidate:-3-5 years clinical practice experience, preferably in acute care, in a hospital setting. -2 years managed care experience. -RN with current unrestricted state licensure, BSN desirable. -Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.-Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word. -Ability to effectively participate in a multi-disciplinary team including internal and external participants. -Initiative, innovation, flexibility, decisiveness and creativity. -Self-directed and motivated to achieve positive outcomes for members. -Excellent/Proven clinical assessment skills with ability to make good decisions and exercise sound clinical and professional judgment as well as manage multiple priorities.EDUCATIONThe highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.LICENSES AND CERTIFICATIONSNursing/Certified Case Manager (CCM) is desiredNursing/Registered Nurse (RN) is requiredFUNCTIONAL EXPERIENCESNursing/Case Management/1-3 YearsNursing/Disease management/1-3 YearsClinical/Medical/Direct patient care (hospital, private practice)/4-6 YearsClinical/Medical/Case management/1-3 YearsNursing/Discharge Planning/1-3 YearsTECHNOLOGY EXPERIENCESAetna Applications/Aetna Strategic Desktop/1-3 YearsAetna Applications/Aetna Total clinical View/1-3 YearsAetna Applications/eTUMS -Total Utilization Management System Internet/1-3 YearsDesktop Tools/Microsoft Outlook/1-3 YearsDesktop Tools/Microsoft Word/1-3 YearsREQUIRED SKILLSBenefits Management/Maximizing Healthcare QualityBenefits Management/Understanding Clinical ImpactsService/Providing Solutions to Constituent NeedsDESIRED SKILLSLeadership/Driving a Culture of ComplianceLeadership/Collaborating for ResultsPlease note that benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Aetna does not permit the use of tobacco related products or drugs in the workplace.
Job Function: Health Care