Aetna Case Manager RN - $2,000 Sign-On Bonus - KS MCD - 51687BR in Overland Park, Kansas

Req ID: 51687BR

Aetna Better Health of Kansas is offering a $2,000 Sign On Bonus for this position. We are looking for people who value excellence, integrity, caring, and innovation. In this role, you will be building a team dedicated to improving the lives of the most vulnerable in our population.

Kansas Medicaid Service Coordination roles are available in all counties and regions. Clinical case management positions are eligible for telework.

Position Summary:

The Case Manager – Registered Nurse (RN) is responsible for assessing members face-to-face and telephonically; and planning, implementing and coordinating all case management activities with members to evaluate the appropriate holistic needs (physical, psychological, social, financial, spiritual, residential) of the member to facilitate the member s overall wellness and care. In doing this, the Case Manager RN develops a proactive course of action to address issues presented to enhance the short and long term outcomes as well as opportunities to enhance a member s overall wellness through integration. Services, strategies, policies and programs are comprised of network management and clinical coverage policies.

Routine field-based travel with personal vehicle is a job requirement. Qualified candidates must have dependable transportation, valid KS state driver s license and proof of vehicle insurance.

Additional Responsibilities of the Case Manager – Registered Nurse (RN):

  • Assessment of members through the use of clinical and non-clinical tools and review of member specific health information/data.

  • Conducts comprehensive assessments of referred members needs/eligibility and in collaboration with the members care team determines an approach to resolving member issues and/or meeting needs by evaluating members benefit plan and available internal and external programs/services and resources; assessments will take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.

  • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex clinical indicators which impact care planning and resolution of member issues.

  • Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical and service providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.

  • 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 and presents cases at case rounds for multidisciplinary focus to benefit members overall health and well-being.

  • Utilizes case management processes in compliance with regulatory and company policies and procedures.

  • Provides coaching, information and support to empower the member to make ongoing independent medical and/or health lifestyle choices; helps member actively and knowledgably participate with their provider in healthcare decision-making.

  • Adheres to care and quality management processes in compliance with regulatory and accreditation guidelines and company policies/procedures; and utilizes influencing/motivational interviewing skills to ensure maximum member engagement and to promote lifestyle/behavioral changes to achieve optimum level of health.

    Required Skills for the Case Manager – Registered Nurse (RN):

  • Minimum of 3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care.

  • Registered Nurse licensure.

  • Computer literacy and proficiency with Microsoft Excel, Word, including navigating multiple systems and keyboarding.

  • Qualified candidates must have the ability to support the complexity of members needs including face-to-face visitation.

  • Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.

  • Knowledge of community resources and provider networks.

  • Familiarity with local health care delivery systems.

  • Strong documentation skills.

  • Ability to work independently and as part of a team.

  • Strong communication skills (written and oral).

  • Strong organizational skills.

    Preferred Skills for Case Manager – Registered Nurse (RN):

  • Case management and discharge planning experience.

  • Managed care experience.

  • Crisis intervention skills.

  • Bilingual Spanish speaking skills.

  • Bachelor of Science in Nursing degree.

  • Experience working with the intellectual and developmental disabilities population.

  • Previous experience conducting face-to-face care management.

  • Behavioral health experience.

    Education:

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

    (BSN preferred)

    Licenses:

    Active unrestricted KS State Registered Nurse (RN) Licensure is Required.

    Telework Specifications:

    Position is office-based now. Telework may commence following successful completion of onboarding, training and demonstrated attendance and performance with assigned caseload. In our experience, the timeframe for telework commencement may vary.

    If you wish to speak to a Talent Acquisition Representative directly, please call (866) 423-0550.

    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 candidate'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.

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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.