Aetna Case Manager RN in Trenton, New Jersey

Req ID: 54337BR

This role is open to WAH for candidates that are located in the Philadelphia/Southern NJ and Delaware area and is commutable to Jefferson and Mainline hospitals in Southern PA.

POSITION SUMMARY

Facilitates clinical collaboration across Delaware Valley ACO (DVACO) relative to improved management of medical spend, quality measures and member satisfaction. Dedicated liaison between Aetna Healthcare Vertical (HV) CAT and local DVACO clinical resources focused on coordination on HIGH risk and emerging risk attributed EE plan membership.

Fundamental Components:

This dedicated clinical collaboration role will report into the Albany, NY clinical team. It is a requirement to be located near the DVACO service area (Philadelphia/Southern NJ and Delaware) area to be able to attend in person and ad hoc monthly collaboration meetings with DVACO team. Primary responsibilities will include identifying high risk case collaboration opportunities and facilitating case review meetings as part of optimizing DVACO member engagement to improve outcomes; required utilization of population health and emerging high cost claimant reporting to support efforts with DVACO team. Will work with other HV Albany, NY clinical resources dedicated to support DVACO membership and functionally be aligned to Albany, NY HV operational team.

Assist in the planning, facilitation and ATV documentation of clinical collaboration processes with DVACO resources; focused coordination on high risk and emerging risk for improved population health management; ability to review reporting to determine cases for collaborative management and support. Works closely with DVACO organization to identify opportunities for enhanced collaboration to achieve optimal engagement and member support/advocacy.

BACKGROUND/EXPERIENCE desired:

-3-5+ years of clinical experience (Required)

-Unrestricted RN licensure (Required)

-5-10+ years strong background in health care analysis methods and tools, Population health, care management including disease management, complex care or end of life; (Highly Preferred)

-Outstanding verbal and written communication skills, including strong collaboration/influencing abilities; (Required)

-5-10+ years in either payer or provider settings; (Highly Preferred)

-Deep knowledge of health care industry, ability to facilitate clinical collaboration

-Strategic business acumen and proven organizational, management, and leadership skills.

-Strong technical skills and proficiency in the utilization of standard MS Office products including Excel, Word, PowerPoint

-Ideal candidate has an unrestricted nursing license in PA, NJ and DE or is willing to obtain within 1-3 months of hire

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is required

Nursing/Certified Case Manager is preferred

FUNCTIONAL EXPERIENCES

Functional - Nursing/Case Management/4-6+ Years

Functional - Nursing/Concurrent Review/discharge planning/1-3+ Years

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

TECHNOLOGY EXPERIENCES

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

Technical - Aetna Applications/Aetna Total clinical View/4-6+ Years/End User

Technical - Desktop Tools/Microsoft PowerPoint/1-3+ Years/End User

Technical - Desktop Tools/TE Microsoft Excel/1-3+ Years/End User

REQUIRED SKILLS

Leadership/Driving a Culture of Compliance/FOUNDATION

Leadership/Collaborating for Results/ADVANCED

DESIRED SKILLS

General Business/Turning Data into Information/FOUNDATION

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Telework Specifications:

Flexible telework / onsite schedule (must live in Philadelphia/Southern NJ/Delaware area)

ADDITIONAL JOB INFORMATION

Looking for someone who would like to support population health from the front lines. Motivated nurse with a passion to make a difference.

The ideal candidate will have:

Strong organizational and time management skills;

Critical thinking skills.

Resolution focused with high attention to detail, accuracy, collaborative problem solving and follow up.

Ability to flex work hours at times to meet business needs; thrives in a fast paced work environment.

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.