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Hours Full-time, Part-time
Location washington, District of Columbia

About this job

This is an exciting opportunity with Aetna International. This is an office based position that can be located in any Aetna office with a preference for candidates to be located near Blue Bell, PA, Washington DC, or Hartford, CT. International healthcare experience is preferred. The opportunity for work at home will be considered. The preferred hours for the position are Monday - Friday 7:00am EST - 4:00pm EST.

Bilingual in English & Arabic is required.

POSITION SUMMARY

The Case Manager for Aetna International will utilize a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

Primary job functions include, but are not limited to:

-Pre-certification work

-Member case management

-Assisting with evacuation cases

The Case Manager will provide clinical analysis of plan sponsor reports and assist with project management as needed.

Fundamental Components:

Case Manager will use holistic approach to consult with supervisors, peers, Medical Directors, and/or other programs to overcome barriers to meeting goals and objectives in order to achieve optimal outcomes. Will utilize influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health. Will provide coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

The case manager utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures, identifies and escalates quality of care issues through established channels, acts as liaison to Internal Aetna Account Teams and Customer Service teams as needed, and assist to develop, implement and support program policies and procedures as needed. Will provide support to Manager/Supervisor as directed and responds to issues and inquiries promptly and urgently as needed.

BACKGROUND/EXPERIENCE desired:

3-5 years direct clinical practice experience (hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility) required.

International clinical experience preferred.

Case management and discharge planning experience preferred.

Managed care/utilization review experience preferred.

Crisis intervention skills preferred.

Bilingual in English & Arabic required.

EDUCATION

The highest 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.

Certified Case Manager (CCM) is preferred.

FUNCTIONAL EXPERIENCES

Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years

Functional - Nursing/Case Management/1-3 Years

Functional - Nursing/Neonatal Intensive Care/1-3 Years

Functional - Nursing/Oncology/1-3 Years

Functional - Project Management/Cross-functional project management/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/Milliman/1-3 Years/End User preferred

Technical - Aetna Applications/AetInfo Reporting/1-3 Years/End User preferred

Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User preferred

Technical - Desktop Tools/Documentum/1-3 Years/End User required

REQUIRED SKILLS

Benefits Management/Encouraging Wellness and Prevention/ADVANCED

Benefits Management/Understanding Clinical Impacts/ADVANCED

Benefits Management/Maximizing Healthcare Quality/ADVANCED

DESIRED SKILLS

Leadership/Fostering a Global Perspective/FOUNDATION

General Business/Communicating for Impact/FOUNDATION

ADDITIONAL JOB INFORMATION

The preferred hours are MF 7:00am EST - 4:00pm EST.

This is an office based position and can be located in any Aetna office. Manger's preference is that the case manager live near Hartford, CT, Blue Bell, PA, or Washington DC.

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.

We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Employment Type Regular Career Band Description Professional