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Aetna Workers Compensation RN Field Case Manager Registered Nurse in Southfield, Michigan

Req ID: 64594BR

Job Description

JOIN OUR GROWING TEAM

Are you tired of bedside nursing?

Are you looking to get away from 12-hour hospital shifts while continuing to utilize your RN expertise to impact the lives of patients in your local community?

We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Workers Compensation Field Case Management team. This opportunity offers a competitive salary, full benefits, and a performance-based bonus paid out on a monthly or quarterly basis. Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, and flexibility as you coordinate the care of your members.

Territory Western Metro Detroit area, Livonia, Farmington Hills, Canton, Ann Arbor, Novi, Commerce Twp and Plymouth.

The Case Manager uses a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual s and family s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.

Fundamental Components included but are not limited to:

Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, work-sites, or physician s office to provide ongoing case management services.Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.Prepares all required documentation of case work activities as appropriate.Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.Provides educational and prevention information for best medical outcomes.Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.Testifies as required to substantiate any relevant case work or reports.Conducts an evaluation of members/clients needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. 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/client s overall wellness through integration. Monitors member/client progress toward desired outcomes through assessment and evaluation.

All employees are expected to embody our values of Excellence, Integrity, Caring and Inspiration in all that they do as an employee. The overall responsibility of the Field Case Manager is to ensure the injured worker receives the best possible care in a timely and efficient manner towards full rehabilitation and return to work. Please note that we do offer mileage reimbursement for local travel.

As a Workers Compensation Field Case Manager, you will be offered:

Autonomy

Productivity incentives

Monday-Friday schedule

Reimbursement for mileage, tolls, parking, licensure and certification

Laptop, iPhone & printer/fax/scanner all in one.

All major holidays are paid time off, vacation and sick time off is accrued. Full benefits offered including 401(k) and many corporate discounts available. Employees are reimbursed for fees to maintain licensure as well as free CEU s to maintain licensure. Continuing Education credits are available/provided for RN and a various industry certifications too. Work from home with in-state travel. In addition to annual salary, position has potential for a monthly monetary bonus.

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

Qualifications Requirements and Preferences:

BACKGROUND/EXPERIENCE:

3+ years clinical practice experience.

3+ years case management experience with workers compensation, disability, and auto liability preferred.

If no case management experience, 5 years of Home Health Care and/or Hospice care.

Bilingual in Spanish preferred.

Knowledge of laws and regulations governing delivery of rehabilitation services.

Effective communications, organizational, and interpersonal skills.

Ability to work-independently, requires working from home in a safe and secure environment.

Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.

Effective computer skills including navigating multiple systems and keyboarding

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse (RN) is required

Prefer any of the following credentials in good standing: CCM, CDMS, COHN, COHN-S, CRRN.

Nursing - CRRN - Certified Rehabilitation Registered

Nursing - Certified Disability Management Specialist (CDMS)

Nursing - Certified Occupational Health Nurse

Nursing - Certified Case Manager (CCM)

FUNCTIONAL EXPERIENCES

Functional - Nursing/Case Management/1-3 Years

Functional - Nursing/Home Health Care/4-6 Years

Functional - Nursing/Occupational/1-3 Years

Functional - Nursing/Medical-Surgical Care/4-6 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User

Technical - Desktop Tools/Microsoft Word/4-6 Years/End User

Technical - Desktop Tools/Microsoft Explorer/4-6 Years/End User

Licenses/Certifications:

Nursing - Registered Nurse

Functional Skills:

Nursing - Case Management, Nursing - Home Health Care Ambulatory Nursing, Nursing - Occupational

Technology Experience:

Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Required Skills:

General Business - Applying Reasoned Judgment, Service - Case Administration, Service - Providing Solutions to Constituent Needs

Desired Skills:

General Business - Communicating for Impact, Leadership - Collaborating for Results, Service - Handling Service Challenges

Additional Job Information:

This is a work from home position where the ideal candidate will reside in western Metro Detroit. The employee will travel daily to appointments throughout SE Michigan including Metro Detroit and Ann Arbor. Employees travel from home on a daily basis, at least half the day or more on the road; employees receive mileage reimbursement until eligible for a company car. Candidates must have very strong competency with technology including computers and cell phones; as well as very strong organizational skills. Employees coordinate and attend physician visits with clients to review medical status, identify and resolve medical barriers and coordinate treatment including therapies, transportation and DME's as needed.

Benefit Eligibility

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

Job Function: Healthcare

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.

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