Aetna Case Manager RN Registered Nurse in High Point, North Carolina

Req ID: 56043BR

POSITION SUMMARY

This Case Manager role works telephonically with members who have medical, commercial insurance coverage through an employer-based health plan. Through the process of assessment, planning, and advocacy the case manager will help the member achieve their highest level of health in the most appropriate and cost-effective setting. Ideal candidates will have general medical/surgical experience, or experience in specialty areas such as Oncology, Orthopedics, Intensive Care, Emergency Department or Home Health. All clinical experience will be considered. All member and provider contact is by phone or electronic media with an expectation that timeliness standards are met. An example of a member you might work with as an Aetna Case Manager would be someone who has just had an acute hospitalization and need assistance such as home healthcare, equipment or office visits. They may also have educational needs surrounding their hospital stay, such as pain control, wound self-management, medication adherence or managing their chronic conditions. This is where our Case Managers becomes a much needed resource and advocate for members who have left the acute setting and are now challenged with recovering and getting back to their previous level of functioning and achieving their ultimate level of health.

Fundamental Components but not limited to the following:

The Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs, overall wellness and/or appropriate and timely return to work. The case manager develops a proactive course of action to enhance short and long term outcomes as well as identifying opportunities to enhance a members overall wellness through integration with partner programs. This position is in an office environment using a computer station and may require sitting for extended periods of time.

  • This is ideal for an applicant seeking a fast paced environment.

Full Time positions with business hours, Monday through Friday. To service west coast customers, nurses will be required to work 2-3 times a month until 9:00pm EST after training. The office is located at 4050 Piedmont Parkway, High Point, NC. Work from home opportunities may be available after 12-18 months of employment, determined by business need. Looking for someone who enjoys working in an office in a high energy and motivated team environment. Position is within commutable distance to High Point, Greensboro, Winston-Salem and Burlington!

BACKGROUND/EXPERIENCE:

2+ years of clinical experience (all clinical areas considered: Home Health, Med/Surg, ED, Telemetry, ICU, NICU, Oncology, Long term care, orthopedics, and more!)

Strong computer skills including toggling with Windows, Microsoft Office and Outlook and strong keyboarding skills.

Demonstrated passion for finding solutions to problems faced by patients in the healthcare setting.

Ability to exercise independent and sound judgment, strong decision-making skills and well-developed interpersonal skills.

Ability to manage multiple priorities, effective organizational and time management skills.

This position is in an office environment using a computer station and may require sitting for extended periods of time.

Case Management and/or Managed Care experience is preferred but not required.

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse (RN) is required, unrestricted and multi RN state licenses would be a plus

Nursing/Certified Case Manager (CCM) is preferred

FUNCTIONAL EXPERIENCES

Functional - Nursing/Case Management/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Operating Systems/Windows/1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Supporting Medical Practice/FOUNDATION

Benefits Management/Understanding Clinical Impacts/FOUNDATION

Telework Specifications:

Work from home opportunities may be available after 12-18 months of employment, determined by business need.

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.

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.