Req ID: 60113BR

Job Description

Candidates must be on the West Coast (telework) or will need to be in the Blue Bell, PA office.

Utilizes clinical skills to coordinate, document and communicate an assessment of functional capacity to be used in disability claims management.

Fundamental Components included but are not limited to:

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 member s 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.

Qualifications Requirements and Preferences:

-3+ years clinical practice experience (required)

-RN with current unrestricted state licensure (required)

-Med/Surg, Acute Care, Home Care, Rehab experience (preferred)

-Case Management experience in an integrated model (preferred)

-Bilingual (preferred)

Licenses/Certifications:

Nursing - Certified Case Manager, Nursing - Registered Nurse

Functional Skills:

Nursing - Case Management, Nursing - Home Health Care Ambulatory Nursing, Nursing - Medical-Surgical Care

Technology Experience:

Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word

Required Skills:

Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Supporting Medical Practice, Benefits Management - Understanding Clinical Impacts

Desired Skills:

General Business - Applying Reasoned Judgment

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.

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

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.