Aetna Case Manager in Allentown, Pennsylvania

Req ID: 52279BR

POSITION SUMMARY

This is an in-office position in Allentown, PA.

We help our members live fuller and healthier lives while delivering positive financial results to our plan sponsors. Through integrity, compassion and commitment to best-in-class service, we educate members, facilitate treatment plans and partner with constituents to create innovative service models

Fundamental Components:

Responsible for the review and evaluation of clinical information and documentationReviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issuesIndependently coordinates the clinical resolution with internal/external clinician support as required

BACKGROUND/EXPERIENCE:5+ years clinical practice experience requiredUnrestricted active RN licensure in PA required Excellent communication skillsAble to work in multiple web-based applications simultaneously

Bilingual preferredCase management experience preferredAbility to multi-task and problem-solveIndependent thinker

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is required

Nursing/Certified Case Manager (CCM) is desired

FUNCTIONAL EXPERIENCES

Functional - Nursing/Medical-Surgical Care/1+ Years

Functional - Nursing/Case Management/1+ Years

Functional - Nursing/Quality Management/1+ Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/Aetna Total clinical View/1+ Years/End User

Technical - Aetna Applications/Strategic Contracts Manager/1+ Years/End User

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

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

REQUIRED SKILLS

General Business/Applying Reasoned Judgment/ADVANCED

Leadership/Collaborating for Results/ADVANCED

Leadership/Driving a Culture of Compliance/FOUNDATION

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

ADDITIONAL JOB INFORMATION

We value leadership, creativity, and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company. 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 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.

Job Function: Health Care

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.