Clinical Case Manager
Company Name:
Aetna
Req ID: 22805BR
This is an exciting opportunity with Aetna International. This is an office based position that can be located in any Aetna office. International healthcare experience and bilingual Spanish and/or Portuguese language skills highly preferred. Manager is open to a four day work week if candidate is willing to work 11:00 AM to 9:00 PM EST. Work at home will be considered for qualified internal candidates only.POSITION SUMMARYThe Case Manager for Aetna International will utilize 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. Primary job functions include, but are not limited to: -Pre-certification work-Member case management -Assisting with evacuation casesThe Case Manager will provide clinical analysis of plan sponsor reports and assist with project management as needed.Fundamental Components:Case Manager will use holistic approach to consult with supervisors, peers, Medical Directors, and/or other programs to overcome barriers to meeting goals and objectives in order to achieve optimal outcomes. Will utilize influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health. Will provide coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. The case manager utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures, identifies and escalates quality of care issues through established channels, acts as liaison to Internal Aetna Account Teams and Customer Service teams as needed, and assist to develop, implement and support program policies and procedures as needed. Will provide support to Manager/Supervisor as directed and responds to issues and inquiries promptly and urgently as needed.BACKGROUND/EXPERIENCE desired:3-5 years direct clinical practice experience (hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility) clinical experience preferred.Case management and discharge planning experience preferred.Managed care/utilization review experience preferred.Crisis intervention skills preferred.Bilingual Spanish and/or Portuguese highly highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.LICENSES AND CERTIFICATIONSNursing/Registered Nurse (RN) is required.Certified Case Manager (CCM) is preferred.FUNCTIONAL EXPERIENCESFunctional - Clinical / Medical/Concurrent review / discharge planning/1-3 YearsFunctional - Nursing/Case Management/1-3 YearsFunctional - Nursing/Neonatal Intensive Care/1-3 YearsFunctional - Nursing/Oncology/1-3 YearsFunctional - Project Management/Cross-functional project management/1-3 YearsTECHNOLOGY EXPERIENCESTechnical - Aetna Applications/Milliman/1-3 Years/End User preferredTechnical - Aetna Applications/AetInfo Reporting/1-3 Years/End User preferredTechnical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User preferredTechnical - Desktop Tools/Documentum/1-3 Years/End User requiredREQUIRED SKILLSBenefits Management/Encouraging Wellness and Prevention/ADVANCEDBenefits Management/Understanding Clinical Impacts/ADVANCEDBenefits Management/Maximizing Healthcare Quality/ADVANCEDDESIRED SKILLSLeadership/Fostering a Global Perspective/FOUNDATIONGeneral Business/Communicating for Impact/FOUNDATIONADDITIONAL JOB INFORMATIONManager is willing to consider four 10 hour shifts if case manager is willing to work 11:00 AM - 9:00 PM EST.This is an office based position and can be located in any Aetna office. Manger's preference is that the case manager live near Hartford, CT or Blue Bell, PA. WAH will be considered for qualified internal candidates.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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Job Function: Health CareEstimated Salary: $20 to $28 per hour based on qualifications.
Aetna
Req ID: 22805BR
This is an exciting opportunity with Aetna International. This is an office based position that can be located in any Aetna office. International healthcare experience and bilingual Spanish and/or Portuguese language skills highly preferred. Manager is open to a four day work week if candidate is willing to work 11:00 AM to 9:00 PM EST. Work at home will be considered for qualified internal candidates only.POSITION SUMMARYThe Case Manager for Aetna International will utilize 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. Primary job functions include, but are not limited to: -Pre-certification work-Member case management -Assisting with evacuation casesThe Case Manager will provide clinical analysis of plan sponsor reports and assist with project management as needed.Fundamental Components:Case Manager will use holistic approach to consult with supervisors, peers, Medical Directors, and/or other programs to overcome barriers to meeting goals and objectives in order to achieve optimal outcomes. Will utilize influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health. Will provide coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. The case manager utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures, identifies and escalates quality of care issues through established channels, acts as liaison to Internal Aetna Account Teams and Customer Service teams as needed, and assist to develop, implement and support program policies and procedures as needed. Will provide support to Manager/Supervisor as directed and responds to issues and inquiries promptly and urgently as needed.BACKGROUND/EXPERIENCE desired:3-5 years direct clinical practice experience (hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility) clinical experience preferred.Case management and discharge planning experience preferred.Managed care/utilization review experience preferred.Crisis intervention skills preferred.Bilingual Spanish and/or Portuguese highly highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.LICENSES AND CERTIFICATIONSNursing/Registered Nurse (RN) is required.Certified Case Manager (CCM) is preferred.FUNCTIONAL EXPERIENCESFunctional - Clinical / Medical/Concurrent review / discharge planning/1-3 YearsFunctional - Nursing/Case Management/1-3 YearsFunctional - Nursing/Neonatal Intensive Care/1-3 YearsFunctional - Nursing/Oncology/1-3 YearsFunctional - Project Management/Cross-functional project management/1-3 YearsTECHNOLOGY EXPERIENCESTechnical - Aetna Applications/Milliman/1-3 Years/End User preferredTechnical - Aetna Applications/AetInfo Reporting/1-3 Years/End User preferredTechnical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User preferredTechnical - Desktop Tools/Documentum/1-3 Years/End User requiredREQUIRED SKILLSBenefits Management/Encouraging Wellness and Prevention/ADVANCEDBenefits Management/Understanding Clinical Impacts/ADVANCEDBenefits Management/Maximizing Healthcare Quality/ADVANCEDDESIRED SKILLSLeadership/Fostering a Global Perspective/FOUNDATIONGeneral Business/Communicating for Impact/FOUNDATIONADDITIONAL JOB INFORMATIONManager is willing to consider four 10 hour shifts if case manager is willing to work 11:00 AM - 9:00 PM EST.This is an office based position and can be located in any Aetna office. Manger's preference is that the case manager live near Hartford, CT or Blue Bell, PA. WAH will be considered for qualified internal candidates.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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Job Function: Health CareEstimated Salary: $20 to $28 per hour based on qualifications.
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