Job Description
ABOUT OUR COMPANY
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.
JOB GROUP SUMMARY
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge.
POSITION SUMMARY
The nurse consultant utilizes clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate healthcare outcomes for members.
More specifically, Case Management (CM) is defined as a collaborative process that assesses, plans, implements coordinates, monitors and evaluates options and services to meet an individual's health needs through communication and available resources to promote quality, cost-effective outcomes. The CM process includes: assessing the member's health status and care coordination needs, inpatient review and discharge planning, developing and implementing the CM plan, monitoring and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria.
Job Requirements
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Certified Case Manager is desired
Certified-Advanced Social Work Case Manager is desired
Registered Nurse (RN) is required
FUNCTIONAL WORK EXPERIENCES
Nurses: Case Management
Nurses: Concurrent Review/discharge planning
Nurses: Precertification
Medical Management: Medical Management - Managed Care/Insurance Clinical Staff
REQUIRED SKILLS
Apply clinical criteria and guidelines to ensure appropriate administration of benefits and optimum medical outcomes
Assess members clinical care needs
Build relationship with provider office staff
Collaborating for Results
Develop patient care management plans
Evaluate member progress in meeting case management plan goals
DESIRED SKILLS
Identify cost saving opportunities We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with Aetna.
How to apply
To learn more about this opportunity, visit us athttp://api.careerbuilder.com/v1/joblink?DID=J3G06765VVC61XYQR92&developerkey=WDAW0QF6HDXRBLW245F7 . Under requisition # select 29558 and submit your resume.
We conduct pre-employment drug and background testing.
Aetna does not permit the use of tobacco related products or drugs in the workplace. No agencies, please.
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna's Affirmative Action responsibilities extend to women, minorities, persons with disabilities and veterans. Company policy also provides for equal opportunity for qualified individuals regardless of race, color, sex, national origin, religion, age, disability, veteran status, sexual orientation, gender identity or marital status.
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