Aetna Insurance Jobs – Field Nurse Case Manager RN

Job Description:

Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members. Health service strategies, policies, and programs are comprised of utilization management, quality management, network management, clinical coverage and policies. The position requires advanced clinical judgment and critical thinking skills in order to facilitate appropriate physical, behavioral health, psychosocial wrap around services. The care manager will be responsible for; care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner. Strong assessment, writing and communication skills are required.

Job Responsibilities:

• The Case Manager is responsible for conducting face to face visits in the members home utilizing comprehensive assessment tools for members enrolled in Managed Long-Term Services and Supports program (MLTSS).
• Member assignment may include pediatric population and medically complex cases.
• The case manager is responsible for coordinating and collaborating care with the member/authorized representative, PCP, and any other care team participants.
• The case manager schedules and attends interdisciplinary meetings and advocates on the members behalf to ensure proper and safe discharge with appropriate services in place.
• The case manager works with the member and care team to develop a care plan and authorizes services in a cost-effective manner within the MLTSS benefit.
• The care manager is responsible for documenting accurately and timely in the member’s electronic health record. This position requires the case manager to use critical thinking skills and the ability to problem solve.

Job Requirements:

• 3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
• Active and Unrestricted RN license in NJ required.
• Excellent analytical and problem-solving skills
• Case management and/or discharge planning experience preferred.
• Managed Care experience preferred.
• Crisis intervention skills preferred.
• Associate degree equivalent or higher

Job Details:

Company: Aetna

Vacancy Type:  Full Time

Job Location: Jersey City, NJ, US

Application Deadline: N/A

Apply Here

vacancyoptions.com