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in Detroit, MI

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Hours Full-time, Part-time
Location Detroit, Michigan

About this job

This is an in-office position in Detroit, MI. The Case Manager will be required to visit members in the community within a 50 mile radius of the health plan.

POSITION SUMMARY

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

Fundamental Components

Provide telephonic collaboration of care and services to plan members-90%

Enroll members into the care management program-90%

Achieve and maintain enrolled caseload of 60 members-90%

Access, and document within, multiple database systems-90%

Authorize home care, transplant, and rehab services-10%

Coordinate care and services with assistance of other plan staff members-10%

Attend weekly and as-needed meetings and training sessions

Make face-to-face visits to members in the community-10-25%

Develop new interventions and/or programs

BACKGROUND/EXPERIENCE desired

3-5 years clinical practice experience required (hospital setting, alternative care setting such as home health or ambulatory care).

3-5 years discharge planning experience required

1-3 years disease management experience preferred

Healthcare and/or managed care industry experience preferred.

Case Management experience preferred

RN with current unrestricted state licensure.

Case Management Certification preferred

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 (CCM) is desired

FUNCTIONAL EXPERIENCES

Functional - Nursing/Case Management/4-6 Years

Functional - Nursing/Disease management/4-6 Years

Functional - Nursing/Discharge Planning/4-6 Years

TECHNOLOGY EXPERIENCES

Technical_Experience/Technical_Focus/4-6 Years/Power User

REQUIRED SKILLS

Service/Providing Solutions to Constituent Needs/ADVANCED

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

DESIRED SKILLS

Benefits Management/Understanding Clinical Impacts/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

Leadership/Collaborating for Results/ADVANCED

ADDITIONAL JOB INFORMATION

The position is salaried with no holidays or weekends. The case manager can choose the hours that work best for his/her life. The case management team consists of highly skilled and experienced professionals who make the members their first priority

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