Case Manager RN

Aetna Inc. Miami, FL
Job Description

POSITION SUMMARY

This is a Telephonic Registered Nurse Case and Disease Manager for our Dual Eligible Special Needs Plan population position. 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 and to facilitate the members overall wellness. Developing a proactive individualized care pan to address problems, goals and interventions to enhance the short and long term outcomes as well as opportunities to enhance a members overall wellness.

Fundamental Components include, but are not limited to:

Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary care team meetings

Utilizes case management processes in compliance with regulatory and company policies and procedures

Utilizes interviewing skills to ensure maximum member engagement and appropriate documentation in the members care plan

Effectively identifies complex situations and escalates them to the appropriate level

BACKGROUND/EXPERIENCE desired:

Registered Nurse with an active, unrestricted Florida license

1-3 years clinical practice experience required

1-3 Case and Disease management experience required

Bilingual preferred

EDUCATION

The minimal 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

FUNCTIONAL EXPERIENCES

Functional - Clinical / Medical/Disease management/1-3 Years

Functional - Nursing/Case Management/1-3 Years

Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Understanding Clinical Impacts/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

DESIRED SKILLS

Benefits Management/Supporting Medical Practice/FOUNDATION

Leadership/Collaborating for Results/ADVANCED

Technology/Leveraging Technology/FOUNDATION

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 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.