Aetna Field Case Mgr-Medical in Champaign, Illinois

Req ID: 55816BR

POSITION SUMMARY

As a Field Case Manager, you will partner within our Clinical Team in a collaborative process of assessment, planning, and advocacy to meet a members benefit plan and/or health needs in their home, hospital or other community location.

Fundamental Components:

Through the identification of members via analytics tools, member services or self-referrals, and comprehensive assessments of referred member's needs, the Field Case Manager determines an approach to case resolution and/or meeting needs by identifying potential barriers to care and develops an individualized care management plan using a holistic approach to assist members with achieving their identified health goals. Operates across a multi-disciplinary team, inclusive of other specialized clinicians, to overcome barriers to meeting health goals and objectives and ensuring optimal member health is achieved. Consistently presents appropriate cases at Case Management Rounds to obtain multidisciplinary review in order to achieve optimal outcomes.

Identifies and escalates quality of care issues through established channels Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Knowledge and use of social and community resources to assist members in achieving optimal health are key to the role. This position requires the Case Manager to conduct face to face visits with members enrolled in the case management program. Must have experience in meeting members in their homes, community setting or healthcare facility.

BACKGROUND/EXPERIENCE

RN licensure required

5+ years clinical experience required

Ability to travel within a designated geographic area for in-person case management activities

Case management experience preferred

Home health/ hospice experience preferred

CCM preferred

Excellent analytical and problem solving skills

Effective communications, organizational, and interpersonal skills.

Experience in using multiple online tools to capture the care management plan and activities.

Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.

Effective computer skills including navigating multiple systems and keyboarding

EDUCATION

The minimum level of education required for candidates in this position is a Bachelor'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/1-3 Years

Telework Specifications:

Telework is a requirement for this position (no physical office location). Full-Time Telework (WAH).

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.

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.

Job Function: Health Care

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.