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in Augusta, ME

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Hours Full-time, Part-time
Location Augusta, Maine

About this job

These are work at home/telework/telecommute Case Manager positions that require 2 weeks of onsite training in New Albany, Ohio office.

Minimum internet requirements for a telecommuting position include: A separate wired Internet connection Minimum download speed of 6MB Minimum upload speed of 1mb Satellite and other wireless Internet is NOT supported.

POSITION SUMMARY

Experience in field of case management with history in the field of managed care, or insurance preferred in addition to a clinical background. Candidates should have a specialty background in Oncology, as well as CCM and/or other URAC recognized certification. This position consists of working intensely as a case manager telephonically with patients and their care team for fully and/or self-funded clients.

Fundamental Components:

Enhancement of Medical Appropriateness and Quality of Care:

- Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits.

- Using a holistic approach consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives.

- Identifies and escalates quality of care issues through established channels

- Ability to speak to medical and behavioral health professionals to influence appropriate member care.

- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

- Helps member actively and knowledgeably participate with their provider in healthcare decision-making

- Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.

- Utilizes negotiation skills to secure appropriate options and services necessary.

BACKGROUND/EXPERIENCE desired:

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

3-5 years oncology experience required

3-5 years case management experience required

Managed Care experience preferred

Crisis intervention skills preferred

EDUCATION

The 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

Nursing/Certified Case Manager (CCM) is desired

FUNCTIONAL EXPERIENCES

Functional - Nursing/Case Management/1-3 Years

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

Functional - Nursing/Oncology/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/1-3 Years

Technical - Desktop Tools/Microsoft Word/1-3 Years

Technical - Desktop Tools/TE Microsoft Excel/1-3 Years

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.

Employment Type Regular Career Band Description Professional