Aetna Careers Near Me – Transformation Diabetic RN

Job Description:

Aetna One Advocate is Aetna’s premier service and clinical offering for Aetna nation-wide and creates industry-leading solutions for our customers and members. The model is a fully integrated population health and customer service solution for large plan sponsors. The high-touch, high-tech member advocacy service combines data-driven processes with the expertise of highly trained clinical and concierge member services. Our mission is to meet each member at every aspect of their health care journey. Our embedded customer-dedicated service and clinical pods allow maximization of inbound and outbound touchpoints to solve members’ needs and create behavior change. Our data analytics, white-glove service and end-to-end ownership of member support creates a trusted partner in health. This is an exciting time to join Aetna, a CVS Health company, in our journey to change the way healthcare is delivered today. We are health care innovators.

Job Responsibilities:

• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
• Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
• The Nurse Case Manager role is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
• Assessments include the member’s level of work capacity and related restrictions/limitations.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.

Job Requirements:

• Active and good standing RN licensure in your state
• Minimum of 15 CE hours applicable to diabetes
• Minimum of 1,000 hours providing diabetes education
• (CDCES) Certification Board for Diabetes Care Education required to be obtained within 1 year of employment
• (CDCES) Certification Board for Diabetes Care Education highly preferred
• Familiarity with Microsoft Office products
• Minimum of 2 years professional practice experience
• A Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states

Job Details:

Company: Aetna

Vacancy Type:  Full Time

Job Location: Chandler, AZ, US

Application Deadline: N/A

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