The job below is no longer available.
Registered Nurse (RN) - Bilingual Clinical Care Manager
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | sunrise, Florida |
About this job
Candidates must have at least 3 years of clinical nursing experience and prior experience with Case Management.
Candidates must be bilingual in Spanish.
In this role, candidates will be traveling to provider offices and member's homes 10-25% of the time in the Dade County area.
POSITION SUMMARY
Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members through assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes.
Fundamental Components:
Through the use of clinical tools and review of member specific health information/data, conducts comprehensive assessments of referred member's needs/eligibility and, in collaboration with the member's care team, determines an approach to resolving member issues and/or meeting needs by evaluating the member's benefit plan and available internal and external programs/services and resources. Applies 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. Using advanced clinical skills, performs crisis interventions with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical and service providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services. Application and interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's 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/objectives. Presents cases at case rounds/conferences to obtain a multidisciplinary perspective and recommendations in order to achieve optimal outcomes. Identifies and escalates quality of care issues through established channels. Ability to speak to medical and behavioral health professionals to influence appropriate member care. Utilizes motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health. Provides coaching, information, support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Helps member actively and knowledgably participate with their provider in health care decisions Monitors, evaluates and documents care; develops plans of care to meet member's goals Adheres to care management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
BACKGROUND/EXPERIENCE desired:
3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required . Case management and discharge planning experience required . Managed Care experience preferred Crisis intervention skills preferred Bilingual in Spanish 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 is required
FUNCTIONAL EXPERIENCES
Functional - Clinical / Medical/Disease management/1-3 Years
Functional - Nursing/Case Management/1-3 Years Required
Functional - Medical Management/Medical Management - Case Management/
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Telework Specifications:
There is a potential to work from home part time after training. Work at home is never guaranteed.
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.
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
Candidates must be bilingual in Spanish.
In this role, candidates will be traveling to provider offices and member's homes 10-25% of the time in the Dade County area.
POSITION SUMMARY
Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members through assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes.
Fundamental Components:
Through the use of clinical tools and review of member specific health information/data, conducts comprehensive assessments of referred member's needs/eligibility and, in collaboration with the member's care team, determines an approach to resolving member issues and/or meeting needs by evaluating the member's benefit plan and available internal and external programs/services and resources. Applies 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. Using advanced clinical skills, performs crisis interventions with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical and service providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services. Application and interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's 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/objectives. Presents cases at case rounds/conferences to obtain a multidisciplinary perspective and recommendations in order to achieve optimal outcomes. Identifies and escalates quality of care issues through established channels. Ability to speak to medical and behavioral health professionals to influence appropriate member care. Utilizes motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health. Provides coaching, information, support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Helps member actively and knowledgably participate with their provider in health care decisions Monitors, evaluates and documents care; develops plans of care to meet member's goals Adheres to care management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
BACKGROUND/EXPERIENCE desired:
3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required . Case management and discharge planning experience required . Managed Care experience preferred Crisis intervention skills preferred Bilingual in Spanish 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 is required
FUNCTIONAL EXPERIENCES
Functional - Clinical / Medical/Disease management/1-3 Years
Functional - Nursing/Case Management/1-3 Years Required
Functional - Medical Management/Medical Management - Case Management/
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Telework Specifications:
There is a potential to work from home part time after training. Work at home is never guaranteed.
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.
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
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