Manager Aetna Case Management Jobs in Indiana (NOW HIRING)

Job Description SummarySummaryThe Case Management Manager is responsible for overseeing the daily operations of a multidisciplinary care management team that supports and advances Value Based Care initiatives. This role provides leadership and operational oversight for case management, care coordination, transitional care management, emergency department follow-up, population health programs, and continuity of care activities. The Case Management Manager promotes high-quality, cost-effective patient care while driving improvements in clinical outcomes, utilization management, quality performance, and patient satisfaction. This position requires strong leadership, strategic thinking, and collaboration skills, with the ability to leverage internal and external resources to achieve organizational goals and improve healthcare delivery across the continuum of care.How will you make an impact & RequirementsEssential Duties and ResponsibilitiesIncludes the following. Other duties may be assigned.Manage the day-to-day operations of Value Based Care clinical programs to improve quality, patient outcomes, and operational efficiency.Analyze utilization and population health data to identify opportunities for improved outpatient management and reduced inpatient and emergency department utilization.Develop, implement, and monitor population health initiatives for Value Based beneficiaries.Provide oversight and guidance for high-risk patient case management activities with a focus on reducing preventable emergency department visits, hospital admissions, and readmissions.Supervise and support the multidisciplinary care team, including Case Managers, Social Services staff, Emergency Department Follow-Up Coordinators, Care Coordinators, and Transitional Care Management Nurses.Ensure effective transitions of care for patients discharged from hospitals, skilled nursing facilities, rehabilitation centers, and behavioral health facilities by coordinating:Primary Care Provider follow-up appointmentsSpecialist referralsHome Health servicesDurable Medical Equipment (DME)Community resource and social service supportMonitor and address quality measure performance and care gaps to support organizational quality goals.Develop and facilitate Value Based Care education and training programs for patients, providers, and staff.Participate in quality improvement committees, provider meetings, hospital operational meetings, and other organizational initiatives as required.Monitor organizational strategies and performance metrics to support clinical, operational, financial, and utilization management goals.Lead the successful integration of Value Based Care programs into existing workflows and operational processes.Build and maintain collaborative relationships with providers, community partners, hospitals, post-acute facilities, and other key stakeholders.Identify and implement process improvement opportunities that align with organizational objectives and strategic initiatives.Travel to provider offices, care teams, and organizational sites as needed to provide education, support, and program oversight.CompetenciesTo perform the job successfully, an individual should demonstrate the following competencies:Analysis and Problem AssessmentAbility to gather, analyze, and interpret data to identify trends, gaps, root causes, and opportunities for improvement.CompassionDemonstrates empathy, respect, and commitment to patient-centered care while maintaining confidentiality and professional standards.ComplianceMaintains knowledge of and adheres to all organizational policies, regulatory requirements, compliance standards, and the Code of Conduct.CommunicationCommunicates clearly and effectively in verbal and written formats. Demonstrates strong listening skills and adapts communication style to various audiences.DependabilityConsistently meets deadlines, commitments, attendance expectations, and operational responsibilities while maintaining accountability for results.Leadership and InfluenceMotivates, coaches, and develops team members while promoting collaboration, accountability, and continuous improvement.InnovationIdentifies creative solutions and opportunities to improve workflows, patient outcomes, and operational effectiveness.IntegrityDemonstrates honesty, professionalism, ethical decision-making, and adherence to organizational values.Judgment and Problem SolvingMakes informed, timely decisions by evaluating relevant information, identifying risks, and addressing issues proactively.Performance ManagementEstablishes clear expectations, provides feedback and coaching, supports staff development, and evaluates performance effectively.Organizational AwarenessUnderstands organizational priorities, operations, culture, and stakeholder relationships to achieve strategic objectives.Patient Service OrientationPromotes exceptional patient experiences through proactive engagement, advocacy, responsiveness, and effective problem resolution.Planning and OrganizationPrioritizes workload, allocates resources effectively, and manages multiple initiatives to achieve desired outcomes.Results Orientation and ExecutionDemonstrates accountability for achieving departmental and organizational goals while driving measurable outcomes.Teamwork and CollaborationWorks effectively across departments and disciplines, fostering positive relationships and shared accountability for success.Work StandardsMaintains high standards of performance and professionalism while encouraging excellence within the team.QualificationsTo perform this position successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.Education and ExperienceBachelor's degree in Nursing, Healthcare Administration, Public Health, or a related field preferred.Minimum of three to five years of clinical care management, population health, utilization management, or Value Based Care experience preferred.Prior leadership or supervisory experience preferred.Equivalent combinations of education and experience may be considered.Language SkillsAbility to read, analyze, interpret, and communicate complex healthcare information.Ability to effectively address sensitive inquiries from patients, providers, staff, and business partners.Mathematical SkillsAbility to apply basic mathematical concepts and interpret healthcare utilization and performance data.Reasoning AbilityAbility to identify problems, evaluate information, develop solutions, and make sound decisions in complex situations.Computer SkillsProficiency with Electronic Medical Records (EMR), preferably Athena.Proficient with Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint.Experience utilizing population health, reporting, and care management platforms preferred.Certificates, Licenses, and RegistrationsCurrent Registered Nurse (RN) license in good standing.Case Management Certification (CCM, ACM, or equivalent) preferred.Valid driver's license and reliable transportation, if travel is required.Physical DemandsThe physical demands described are representative of those required to successfully perform the essential functions of this position. Reasonable accommodations may be made for qualified individuals with disabilities.While performing the duties of this position, the employee is regularly required to sit, stand, walk, communicate, and use hands to operate office equipment and technology. Occasional bending, reaching, stooping, and lifting of up to 10 pounds may be required. Specific vision abilities include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.Work EnvironmentThe work environment characteristics described are representative of those encountered while performing the essential functions of this position. Reasonable accommodations may be made for qualified individuals with disabilities.Work is primarily performed in a professional office and healthcare setting. The employee may occasionally travel between provider offices, hospitals, or other care locations. The work environment is generally moderate in noise level and may involve interaction with patients, providers, interdisciplinary teams, and community partners. The position may require flexibility in scheduling to meet operational and organizational needs.Compensation Range:$93,675.00to$140,513.00The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs. #J-18808-Ljbffr