Aetna Registered Nurse (RN) - Case Manager (Clinical Care Manager) - RN, LCSW, LPC in W. Sacramento, California
Req ID: 47456BR
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We anticipate a continued business need for Licensed Clinical Care Managers to join our expanding Aetna Better Health of California team in the San Diego and West Sacramento areas. Apply today for general consideration across current and future potential opportunities! Join the company that is changing the face of health care across the nation. Aetna Better Health of California is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you ll join a team dedicated to improving the lives of the most vulnerable in our population. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of California, and we will support you all the way.
Position SummaryAetna is currently seeking a Licensed Clinical Care Manager to join our California Medicaid team in West Sacramento or San Diego areas. The Licensed Clinical Care Manager will mainly be responsible for utilizing advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members. Additionally, the Licensed Clinical Care Manager will assess and plan member-centered care, direct provider coordination and collaboration, and coordinate psychosocial services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes. Note: This is an in-office position in either West Sacramento of San Diego, CA. There is a travel requirement of 50-75% in the local area to serve members in the community. Responsibilities of the Clinical Care Manager:· Utilize clinical tools to review member specific health information and conduct comprehensive assessments of referred members needs and eligibility · Collaborate with member care teams to determine an approach to resolve member issues or meeting needs by evaluating the members benefit plan and available internal and external programs, services, and resources· Apply 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· Use advanced clinical skills to perform crisis intervention with members experiencing behavioral health or medical crisis and refer them to the appropriate clinical and service providers for thorough assessment and treatment, as clinically indicated · Provide crisis follow up to members to help ensure they are receiving the appropriate treatment and services· Enhance medical appropriateness and quality of care· Monitor, evaluate, and document care Required Qualifications of the Clinical Care Manager:· 3+ years of clinical practice experience, preferably home health, hospital, ambulatory care, or similar Preferred Qualifications of the Clinical Care Manager:· Behavioral healthcare experience is strongly preferred · Case management and discharge planning is strongly preferred· Managed care experience· Crisis intervention skills Education of the Clinical Care Manager:· The highest level of education desired is a Bachelor s degree or equivalent experience · Bachelor s of Science in Nursing (BSN) degree is preferred Licenses and Certifications:Nursing/Registered Nurse (RN) - required Certified Case Manager (CCM) is a plusFunctional Experience: · Functional - Medical Management/Medical Management - Case Management/4+ Years· Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4+ Years· Functional - Medical Management/Medical Management - Direct patient care/4+ Years· Functional - Medical Management/Medical Management - Discharge planning/4+ Years Technology Experience:· Technical - Desktop Tools/Microsoft Word/4+ Years/End User· Technical - Desktop Tools/TE Microsoft Excel/4+ Years/End User· Technical - Desktop Tools/Microsoft Outlook/4+ Years/End User· Technical - Desktop Tools/Microsoft SharePoint/1+ Years/End User
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.
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