Case Manager RN

Aetna Inc. Coatesville , PA 19320

Posted 2 weeks ago

Job Description:

Position Summary

Only applicants willing to travel in Chester County will be considered

Nurse Case Manager is responsible for telephonic and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the members overall wellness.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.

Job Duties:

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. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.

Assessments 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 include the members level of work capacity and related restrictions/limitations.

Using a 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. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Background/Experience desired:
5 years clinical practice experience

Bilingual preferred

Case Management in an integrated model preferred

Education

The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.

Licenses and Certifications

Nursing/Registered Nurse (RN) is required

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.

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.

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.



icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Infusion Nurse RN Accredo

Express Scripts

Posted 4 days ago

VIEW JOBS 4/19/2019 12:00:00 AM 2019-07-18T00:00 POSITION SUMMARY Territory will include Coatesville, and Lancaster PA The primary function of the Infusion Nurse RN is to provide essential in-home IV Infusion medical treatment, response management and follow up care to our clients after receiving a physician order for nursing services. In addition, within an assigned geographical territory, the Infusion Nurse RN will administer infusion therapy and monitor patients in the home during treatment and provide the necessary education on treatment regimen, condition management and treatment self-administration when appropriate. This is a multi-faceted role of nurse, trainer and coordinator and the individual must be calm, professional, and possess the ability and willingness to work with a wide range of personality types in a variety of environments. ESSENTIAL FUNCTIONS * Provide patient clinical coordination in a variety of environments including home, infusion suites, hospitals and doctor offices. * Train patients in the self-administration of treatments, and how to quickly recognize and respond to symptoms of adverse physical reactions to treatments. * Coordinate with pharmacists to address changes in patient condition or drug management issues. * Collaborate and confer with TRC (Therapeutic Resource Center) staff regarding patient status and treatment needs. * Document all interactions and communication with patients, plan of treatment (POT), assessment, treatments, patient responses/reactions to treatment, status of disease process and training activities in a timely manner using company issued tools. * Complete training for new/specialty infusion therapies. QUALIFICATIONS * Registered Nursing (RN) License required * High School Diploma or GED required, plus 8-11 years of relevant work experience with a Nursing Diploma. * 5-8 years of relevant experience with an ASN degree. * 2-5 years of relevant experience with a BSN degree. * Minimum one year experience as a specialized RN in acute or home care/home infusion environment. * Strong venous access skills; must be able to access peripheral veins. * Valid, unrestricted driver's license in state of residence. * Ability to travel within an assigned geographic area. * Availability to work weekend and evening hours if needed, and flexibility to work alternate shifts on short notice. * General knowledge of Microsoft Office, internet and email. * Home internet access is required. * Proficient use/navigation of PC and Apple technology. * Ability to lift and perform repetitive motions. * Critical care experience strongly preferred. * Previous home infusion / home healthcare experience strongly preferred. ABOUT THE DEPARTMENT Through the range of healthcare products and services Accredo offers, team members provide in-depth care for patients with chronic health conditions like hemophilia, oncology, rheumatoid arthritis and growth hormone deficiencies. In addition to the wide range of healthcare products offered to these patients, we provide comprehensive management services, including outcomes measurement, counseling, clinical care management programs, social services and reimbursement services. In these very high-touch roles, employees leave every day knowing they made a positive impact on patient lives. ABOUT EXPRESS SCRIPTS Advance your career with the company that makes it easier for people to choose better health. Express Scripts is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes. Join the company that Fortune magazine ranked as one of the "Most Admired Companies" in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services. We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan. Express Scripts is an equal opportunity employer/disability/veteran Express Scripts Coatesville PA

Case Manager RN

Aetna Inc.