Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Case Manager RN

Expired Job

Aetna Inc. Lowell , MA 01850

Posted 4 weeks ago

Job Description:

POSITION SUMMARY

Registered Nurse experience in field of case management with history in the field of managed care, or insurance preferred in addition to 5 years clinical background as an RN. Prefer candidates have a specialty background of Oncology or Transplant as well as CCM and/or other URAC recognized certification. This position consists of working intensely as a case manager telephonically with patients and their care team for fully and/or self-funded clients.

This is a work-at-home/telework/telecommute Case Manager position that require 2 weeks of on-site training in the New Albany, Ohio office upon hire.

Fundamental Components:

Enhancement of Medical Appropriateness and Quality of Care:

  • Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits.

  • Using a holistic approach consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives.

  • Identifies and escalates quality of care issues through established channels.

  • Ability to speak to medical and behavioral health professionals to influence appropriate member care.

  • Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Incorporate the use of motivational interviewing with patients.

  • Helps member actively and knowledgably participate with their provider in healthcare decision-making.

  • Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.

  • Utilizes negotiation skills to secure appropriate options and services necessary.

Qualification Requirements & Preferences:

  • Minimum of 5 years clinical practice experience, as an RN e.g., hospital setting, alternative care setting such as home health or previous Case Management experience required.

  • Need to actively reach out and engage the patients.

  • Requires ability to document electronically using keyboard and computer screens - free form text.

  • Discharge planning experience preferred.

  • Managed Care experience preferred

Education:

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

Licenses:

Active, unrestricted Registered Nurse (RN) license is required.

Nursing/Certified Case Manager (CCM) is preferred.

Telework Specifications:

Full-Time Telework (WAH)

Considered for any US location; 2 week training period in the New Albany, Ohio office is required

FUNCTIONAL EXPERIENCES

Functional

  • Nursing/Case Management/1-3 Years

Functional

  • Nursing/Oncology/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

Technical

  • Desktop Tools/TE Microsoft Excel/1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Understanding Clinical Impacts/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 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.


See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere
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
Probation Case Specialist

Massachusetts Court System

Posted 1 week ago

VIEW JOBS 12/7/2018 12:00:00 AM 2019-03-07T00:00 NOTES This position is designated as a union position and is covered by the Collective Bargaining Agreement with O.P.E.I.U., Local 6. All candidates must be able to travel among the offices and sessions within the division and are subject to assignment and/or reassignment at any time to any of the offices or sessions of the division at the discretion of the department head. Sessions include: Cambridge, Framingham, Waltham, Woburn, and Lowell. MISSION STATEMENT OF THE MASSACHUSETTS TRIAL COURT The Trial Court is committed to: * fair and impartial administration of justice; * protection of constitutional and statutory rights and liberties; * equal access to justice for all in a safe and dignified environment with policies and practices that strengthen and support diversity, equity, and inclusion; * efficient, effective, and accountable resolution of disputes; * prompt and courteous service to the public by committed and dedicated professionals utilizing best practices in a manner that inspires public trust and confidence. DEPARTMENTAL MISSION STATEMENT The Massachusetts Probation Service's mission is to increase community safety, reduce recidivism, contribute to the fair and equitable administration of justice, support victims and survivors, and assist individuals and families in achieving long term positive change. ORGANIZATIONAL PROFILE: https://www.mass.gov/orgs/massachusetts-probation-service POSITION SUMMARY SUMMARY OF SERIES: This series is responsible for performing a variety of duties related to the processing of cases, including entering of data in automated systems, within a Probation Office. In addition to case processing duties, this series is also responsible for providing service to the public and other individuals who have business with the court consistent with policies on confidentiality. The position titles above the entry level require the performance of increasingly more responsible and varied work which requires more knowledge of court procedures and Probation operations and the exercise of more independent judgment. Employees are hired at the entry level position title and are eligible for reclassification to the higher level position titles within this series consistent with the specifications for the higher level position titles. The position titles revert to the entry level when there are vacancies. ORGANIZATIONAL LEVELS: This position is part of a series that includes a number of levels. Employees are appointed to the entry level and are eligible to advance to the higher levels consistent with this job description and Trial Court policies. Probation Case Specialist I - This is the entry level position title within this series. Employees at this level are expected to perform a variety of duties which teach them the business of the office or a major work unit within an office. Probation Case Specialist II - This is the second level position title within this series. Employees at this second level are expected to perform more complex case processing functions within a major work unit of an office and to be able to perform those functions within the other major work units as required. They are also expected to perform administrative support functions. Probation Case Specialist III - This is the third level position title within this series. Employees at this third level are expected to perform advanced case processing functions within a major work unit of an office with limited supervision, to be able to perform those functions within the other major work units, and to be able to provide occasional assistance in a court session as required. Probation Case Specialist IV - This is the fourth level within this series. Employees at this fourth level are expected to function as a resource person within a major work unit of an office, to be able to perform the full range of case processing responsibilities in all work units as required, to assist in the training of employees, and to be able to provide regular assistance in any court session as required. May also serve as a back-up to a Probation Case Coordinator. MAJOR DUTIES Probation Case Specialist I Duties: Provides customer service to attorneys, litigants, law enforcement personnel, and the general public. This includes assisting individuals in filling out forms and applications, and responding to routine requests for information concerning cases, scheduling and court procedures. May use specialized communication skills in performing these duties; Receives training and assists experienced users on MassCourts, a comprehensive, integrated case management system which features electronic filing of complaints, extensive docketing, scheduling, and management reporting; or on another case processing system; Retrieves criminal records, enters initial data, and updates records and orders in various automated systems; Requests information from other agencies, departments, and or courts; Answers incoming phone calls, routes callers to appropriate personnel, takes messages, and provides routine information in response to inquiries; Prepares lists and other standard documents, and sends out notices to parties and attorneys; Verifies daily list with the Clerk-Magistrate's office; Copies, files, retrieves, and sorts court papers, documents, and folders according to established procedures. Pulls folders for court sessions; Receives, date stamps, sorts, and distributes incoming mail. Processes outgoing mail; Performs cashiering duties, including receiving money, determining case type, making entries in the cash register or other system, validating case papers to reflect payments, and issuing receipts; Maintains statistical data concerning case processing activities; and Performs related duties as required. Probation Case Specialist II Additional Duties: Provides customer service to attorneys, litigants, law enforcement personnel, and the general public. This includes providing information of a more specialized and or detailed nature. May use specialized communication skills in performing these duties; Performs more complex case processing functions, including reviewing court documents, papers, reports, and filings for accuracy and completeness and determining processing required prior to entering them in the permanent record, identifying inaccuracies and or discrepancies and taking action to resolve inaccuracies and discrepancies within established guidelines, or referring unusual problems to a supervisor; Performs more extensive administrative support work Probation Officers, including typing case folders, violation hearing notices, pre-sentence investigations, probation transfers, letters, reports, and other non-standard documents using word processing software as required. Also collects supporting documentation as necessary; Performs routine administrative duties such as preparing internal requisitions, payment vouchers, encumbrance documents, and CAPS forms as required; Serves as a "floating case specialist" who is able to fill-in for employees within other work units as required; Performs all of the duties of the lower level within this series as required. Probation Case Specialist III Additional Duties: Provides customer service to attorneys, litigants, law enforcement personnel, and the general public. This includes responding to unusual or complicated requests for information. May use specialized communication skills in performing these duties; Performs advanced case processing and data entry functions requiring independent judgment concerning the types of actions to be taken and making determinations as to when it is appropriate to take such actions, including working on complicated merges involving multiple records and the need to collect information from multiple outside agencies; Compares data in various automated systems in order to determine status and to ensure accuracy of information. Resolves discrepancies as needed; Reviews approved motions for release of criminal records for completeness, produces such records or identifies issues for further review by a supervisor; Maintains a data base on individuals referred to community service and other court programs and provides periodic reports; Assists in the training of new employees and in the ongoing training of other employees. Serves as a "floating case specialist" who is able to perform the full-range of case processing duties within an office during absences as required; Assists in special projects as assigned by a supervisor; May provide occasional assistance to courtroom personnel; Performs all of the duties of the lower levels within this series as required; Probation Case Specialist IV Additional Duties: Provides customer service to attorneys, litigants, law enforcement personnel, and the general public. Capable of handling the most unusual and complicated inquiries within established guidelines. May use specialized communication skills in performing these duties; Serves as a resource for the handling of particular functions, including answering questions and assisting in resolving problems; Compiles statistical information on probation activities and prepares periodic reports; Prepares a variety of notices, documents and correspondence requiring a detailed knowledge of applicable terminology, rules, and procedures; Assists in researching open cases to determine their status and to determine further action to be taken; Performs administrative support responsibilities for a supervisor, including composing correspondence for supervisor's review and signature, typing memoranda, reports, and other documents, maintaining an appointment calendar and arranging meetings, and maintaining files; Identifies persons who are behind in payments, researches payment histories, determines further actions to be taken, and maintains appropriate files; Provides assistance to staff in the use of word processing and other software applications; May provide regular assistance and coordination to personnel assigned to the courtroom; May serve as a back-up to a higher level series; Performs all of the duties of the lower levels within this series as required. POSITION REQUIREMENTS These are the minimum requirements necessary to apply for a position of Probation Case Specialist. Probation Case Specialist I Requirements: Graduation from high school or its equivalent. Some general clerical or customer service experience. Ability and experience using personal computers, including word processing software such as MS Word. Experience with spreadsheet software such as MS Excel is preferred. General knowledge of modern office practices and procedures. Ability to serve the public and others with business with the court in a courteous and professional manner. Ability to learn the procedures and functions, manual and automated, of the office to which assigned. Ability to understand and follow verbal and written instructions. Ability to perform routine data entry at an acceptable rate of speed. Ability to establish and maintain effective working relationships with court staff. Ability to communicate effectively with others. Probation Case Specialist II Additional Requirements: A minimum of two of years of experience as a Probation Case Specialist I. Working knowledge and ability to effectively use MassCourts or other court used automated case management system. Working knowledge and training in all of the procedures, manual and automated, related to the cases processed within the Probation Office. Working knowledge of word processing software used by the court and the demonstrated ability to use that software to prepare documents. Demonstrated ability to serve the public and others with business with the court in a courteous and professional manner. Demonstrated ability to provide specialized or technical case processing information. Ability to identify problems with court documents, papers and filings and to take appropriate action. Probation Case Specialist III Additional Requirements: A minimum of two years of experience as a Probation Case Specialist II. Considerable working knowledge of case processing using MassCourts or other court used automated case management system. Considerable knowledge and training in all of the procedures, manual and automated, related to all of the cases processed by the Probation Office. Working knowledge of the fiscal policies of the Trial Court and ability to prepare fiscal reports. Demonstrated ability to serve the public and others with business with the court in a courteous and professional manner. Demonstrated ability to respond to unusual or complicated requests for information. Demonstrated ability to process complicated cases from beginning to end. Demonstrated ability to work without close supervision. Probation Case Specialist IV Additional Requirements: A minimum of two years of experience as a Probation Case Specialist III. Considerable working knowledge of all probation related case processing using MassCourts or other court used automated case management system. Considerable knowledge of all courtroom policies and procedures and demonstrated ability to provide assistance during any court session. Considerable knowledge of word processing software used by the court and the demonstrated ability to use that software to perform complex functions such as merge letters, macros, templates, etc. Familiarity with spreadsheets. Demonstrated ability to serve the public and others with business with the court in a courteous and professional manner. Demonstrated ability to respond to difficult and sensitive requests for information. Demonstrated ability to function as a resource person. Demonstrated ability to prepare statistical and written reports. Demonstrated ability to train employees. Demonstrated ability to conduct research on case files and systems and to prepare reports. OTHER PLEASE NOTE: Employment is contingent upon passage of a criminal record check. If you are not currently viewing this posting online, please visit the Judicial Court Jobs website at www.mass.gov/courts to apply for this position or any other Trial Court employment opportunity. No applications or resumes will be accepted by hand, mail, fax, or email delivery. AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER Massachusetts Court System Lowell MA

Case Manager RN

Expired Job

Aetna Inc.