Aetna Utilization Review Jobs (NOW HIRING)

Company Description
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. Excellent benefits package, including 401k, tuition, licensure and certification reimbursement. We promote healthy & wellness lifestyles and offer specialty programs here at Aetna.
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.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
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.
Job Description
*JVS Job Title
Case Manager RN
*Job Description
POSITION SUMMARY
The RN Case Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members through assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes. Routine field based travel is required with personal vehicle.
Qualified candidates must have an active RN license for the State of VA, dependable transportation, a valid and active VA driver's license and proof of vehicle insurance.
Fundamental Components:
Assessment of Members:
-Through the use of clinical tools and review of member specific health information/data, conducts comprehensive assessments of referred members needs/eligibility and, in collaboration with the members care team, determines an approach to resolving member issues and/or meeting needs by evaluating the members benefit plan and available internal and external programs/services and resources.
- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex clinical indicators which impact care planning and resolution of member issues.
- Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical and service providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
- Enhancement of Medical Appropriateness and Quality of Care.
- Monitoring, Evaluation and Documentation of Care Certified Case Managers.
Telework Specifications:
WAH is anticipated, timeline for transition to work at home post training completion and demonstrated performance. Positions will require frequent and routine field based travel.
ADDITIONAL JOB INFORMATION
Education and Certification Requirements: Registered Nurse required (BSN preferred): and Active unrestricted RN state licensure (RN). Additional background and experience desired: Previous experience conducting face-to-face care management is a plus; qualified candidates must have the ability to support the complexity of members needs including face-to-face visitation Computer literacy and proficiency with Microsoft Excel, Word, including navigating multiple systems and keyboarding Ability to multitask, prioritize and effectively adapt to a fast paced changing environment Knowledge of community resources and provider networks Familiarity with local health care delivery systems Behavioral Health experience is a plus Strong documentation skills Ability to work independently and as part of a team Strong communication skills, written and oral Strong organizational skills. Ability to travel in the field required with personal vehicle. Must possess reliable transportation, valid and active driver's license and proof of insurance required.
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 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.
Qualifications
Qualification Requirements:
- 3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
- Case management and discharge planning experience required.
- Managed Care experience preferred.
- Crisis intervention skills preferred.
- Bilingual English/Spanish speaking skills are highly desired.
Education:
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Licenses and Certifications:
Active Registered Nurse licensure for the State of VA is required.
FUNCTIONAL EXPERIENCES
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years
Functional - Medical Management/Medical Management - Case Management/4-6 Years
Functional - Medical Management/Medical Management - Managed Care/Insurance Administration/4-6 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/4-6 Years/End User
REQUIRED SKILLS
Benefits Management/Understanding Clinical Impacts/FOUNDATION
Technology/Leveraging Technology/FOUNDATION
Benefits Management/Supporting Medical Practice/FOUNDATION
DESIRED SKILLS
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
General Business/Applying Reasoned Judgment/ADVANCED
Leadership/Fostering a Global Perspective/FOUNDATION
Additional Information
We offer you:
Autonomy
Productivity incentive
Home every night, weekend and holiday!
Schedule Monday-Friday
All major holidays are paid time off, vacation and sick time off is accrued. Full benefits offered including 401(k) and many corporate discounts available. Employees are reimbursed for fees to maintain licensure as well as free CEU's to maintain licensure Continuing Education credits are available/provided for RN and a various industry certifications too. Work from home with in-state travel. In addition to annual salary, position has potential for a monthly monetary bonus. Mileage reimbursement is provided per the IRS rate.
Coventry provides laptop, IPhone, fax/scanner/printer, as well as office supplies.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
All employees are expected to embody our values of Excellence, Integrity, Caring and Inspiration in all that they do as an employee. The overall responsibility of the Field Case Manager is to ensure the injured worker receives the best possible care in a timely and efficient manner towards full rehabilitation and return to work.
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.