Consulting Case Manager

Job Description

POSITION SUMMARY

We are building an exciting new clinical and member experience program at Aetna. Aetna Community Care is a member centric, team-delivered, community-based care management model that joins members where they are.

The Field Care Manager is a members first point of contact across a larger community-based interdisciplinary care team. The Field Care Manager provides long-term care management support to a member through a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy. The Field Care Manager connects members to the resources and services, available in their own community, to support the members comprehensive health needs while promoting quality care and cost effective outcomes.

Fundamental Components:

Responsible for long-term care management of eligible Aetna members with complex care needs; partners with an interdisciplinary team to deliver comprehensive, community-based care management services focused on helping the member maximize best health outcomes.

Interacts with members in-person, in their home on a regular basis; also meets members at work-sites, a physicians office, or at an agreed upon community location such as a library.

Interacts with members telephonically, following at least the minimum standard of contact required per member based on their level of intervention.

Completes in-person and telephonic assessments and care management support to members daily.

Conducts individualized assessments to identify problems, goals, & interventions with corresponding measurable outcomes that drive the content of the holistic, member centered care plan.

Develops a healthy action plan in partnership with the member, defining problems, goals, and objectives to improve the members overall wellbeing/quality of life, continuously partners with the member to evaluate the members progress in setting/meeting the established goals, revising/updating the health action plan accordingly.

Utilizes influencing and motivational interviewing skills to ensure maximum member engagement; promotes lifestyle and behavior changes to achieve optimum level of health.

Helps members actively and knowledgeably participate with providers in healthcare decision-making; helps members actively and knowledgeably participate with community-based organizations able to support in meeting health goals. Conducts assessments for members discharged from an in-patient hospital or skilled nursing facility; supports post discharge plan of care for both members assigned within their case load and members outside of the case load but residing within their local community.

Demonstrates proficiency with operating in a remote environment, connecting hardware/software, managing email in an Outlook account, and using remote communication software such as Skype & WebEx.

Able to demonstrate proficiency with Word, Excel, and experience documenting within an electronic health record.

Other requirements include: ability to flex work hours to meet the member scheduling needs, ability to travel within a designated geographic area for in-person care management activities distance is reasonable but not fully defined by one-way mileage limits.

BACKGROUND/EXPERIENCE desired:

Minimum of 3 years care/case management experience required

Minimum of 3 years clinical experience required;

Registered Nurse with active state license in good standing

CCM Certification desired 1+ years of community-based experience preferred, particularly within an interdisciplinary care team

Health Plan experience preferred

Managed Care, Medicare/Medicaid, or Commercial Professional certifications preferred (CMCN, GCM, CRC, CDMS, CRRN, COHN, or CCM).

The ability to express oneself clearly both in writing and verbally. RN Required, Active in the State of NJ.

Bilingual (Spanish) preferred.

Must have/or the ability to obtain broadband connectivity prior to start date.

EDUCATION

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

Telework Specifications:

Mobile position - requires travel in the following zones/counties: Zone 1; Union County.

ADDITIONAL JOB INFORMATION

Registered Nurse with active state license in good standing CCM Certification desired

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.

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.