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Case Manager - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | mount laurel, New Jersey |
About this job
POSITION SUMMARY
Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical and psychosocial needs of the member to facilitate the members overall wellness and independence. In doing this the NCM 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 members overall wellness through integration of internal programs and community resources. CM will work within the parameters of Medicare regulations and the specific plan benefits.
Fundamental Components:
Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Assessments will take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures.
BACKGROUND/EXPERIENCE desired:
- 1-3 years clinical practice experience
- Bilingual a plus
- Prior case management experience preferred
- Case management certification is preferred, willingness to obtain within 3 years if hired
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
FUNCTIONAL EXPERIENCES
Functional - Nursing/Medical-Surgical Care/1-3 Years
Functional - Nursing/Case Management/1-3 Years
REQUIRED SKILLS
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Understanding Clinical Impacts/FOUNDATION
General Business/Turning Data into Information/FOUNDATION
DESIRED SKILLS
Benefits Management/Supporting Medical Practice/FOUNDATION
General Business/Applying Reasoned Judgment/ADVANCED
General Business/Consulting for Solutions/ADVANCED
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.
Employment Type Regular Career Band Description Professional
Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical and psychosocial needs of the member to facilitate the members overall wellness and independence. In doing this the NCM 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 members overall wellness through integration of internal programs and community resources. CM will work within the parameters of Medicare regulations and the specific plan benefits.
Fundamental Components:
Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Assessments will take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures.
BACKGROUND/EXPERIENCE desired:
- 1-3 years clinical practice experience
- Bilingual a plus
- Prior case management experience preferred
- Case management certification is preferred, willingness to obtain within 3 years if hired
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
FUNCTIONAL EXPERIENCES
Functional - Nursing/Medical-Surgical Care/1-3 Years
Functional - Nursing/Case Management/1-3 Years
REQUIRED SKILLS
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Understanding Clinical Impacts/FOUNDATION
General Business/Turning Data into Information/FOUNDATION
DESIRED SKILLS
Benefits Management/Supporting Medical Practice/FOUNDATION
General Business/Applying Reasoned Judgment/ADVANCED
General Business/Consulting for Solutions/ADVANCED
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.
Employment Type Regular Career Band Description Professional