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Case Manager Nurse RN
at Aetna
Dallas, TX

Case Manager Nurse RN
at Aetna
Dallas, TX

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Description: Office Based Opportunity: 2777 Stemmons Freeway - Dallas TX

The Nurse Case Manager is responsible for the telephonic assessment, planning, implementing and coordinating of all case management activities in order to evaluate the member's medical needs and to facilitate the member’s overall wellness. Along with the member, the Nurse Case Manager develops a proactive plan of care to address the issues presented in order to enhance the short and long-term outcomes, and to enhance the member’s overall wellness. The Nurse Case Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Fundamental Components: This position is telephonic in a fast-paced production environment. The Nurse Case Manager will both outreach and receive calls from members, educate members on their disease processes, educate members on preventative care and wellness, collaborate care with providers, and assist members with their needs. The Nurse Case Manager applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers, and to 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. The case manager reviews prior claims to address potential impact on current case management and eligibility; 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; and utilizes case management processes in compliance with regulatory and company policies and procedures. The case manager employs motivational interviewing skills to ensure maximum member engagement and to discern their health status and health needs based on key questions and conversations. There may be some need for travel for face to face visits with members. Background Experience:
Case Management in an integrated model preferred
3+ years clinical practice experience required
RN with current unrestricted state licensure required
Good organizational and time-management skills, computer skills, and excellent customer service skills are required
Bilingual preferred
Additional Job Information: Typical office working environment with productivity and quality expectations. Work requires the ability to perform close inspection of computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written. Some travel for face to face visits to members may be required. Required Skills: Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, Service - Providing Solutions to Constituent Needs Desired Skills: Service - Handling Service Challenges, Service - Working Across Boundaries Functional Skills: Nursing - Case Management, Nursing - Maternal and Infant care, Nursing - Medical-Surgical Care, Nursing - Neonatal Intensive Care, Nursing - Pediatrics Education: Nursing - Registered Nurse (RN) Potential Telework Position: No Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Candidate Privacy Information: Aetna takes our candidate'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.

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