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Aetna Inc.

Case Manager Registered Nurse

Aetna Inc. - Allentown, PA

POSITION SUMMARY We help our members live fuller and healthier lives while delivering positive financial results to our plan sponsors. Through integrity, compassion and commitment to best-in-class service, we educate members, facilitate treatment plans and partner with constituents to create innovative service models Fundamental Components: Responsible for the review and evaluation of clinical information and documentation. Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and\/or provider issues. Independently coordinates the clinical resolution with internal\/external clinician support as required. Requires an RN with unrestricted active license. Excellent communication skills and attention to detail. Ability to multitask, problem solve and be an independent thinker. Able to work in multiple web based applications simultaneously . BACKGROUND\/EXPERIENCE: 3-5 years of clinical practice experience (Required) Bilingual (Preferred) Disability case management experience (Preferred) RN Licensure (Required) EDUCATION The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience. LICENSES AND CERTIFICATIONS Nursing\/Registered Nurse (Required) Nursing\/Certified Case Manager (CCM) (Preferred) FUNCTIONAL EXPERIENCES Functional - Nursing\/Medical-Surgical Care\/1-3 Years Functional - Nursing\/Case Management\/1-3 Years Functional - Nursing\/Quality Management\/1-3 Years TECHNOLOGY EXPERIENCES Technical - Aetna Applications\/Aetna Total clinical View\/1-3 Years\/End User Technical - Aetna Applications\/Strategic Contracts Manager\/1-3 Years\/End User Technical - Desktop Tools\/Microsoft Outlook\/1-3 Years\/End User Technical - Desktop Tools\/Microsoft Word\/1-3 Years\/End User REQUIRED SKILLS Leadership\/Collaborating for Results\/ADVANCED Leadership\/Driving a Culture of Compliance\/FOUNDATION General Business\/Applying Reasoned Judgment\/ADVANCED DESIRED SKILLS Benefits Management\/Maximizing Healthcare Quality\/FOUNDATION Technology\/Leveraging Technology\/FOUNDATION ADDITIONAL JOB INFORMATION 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. 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. Job Function: Health Care

7 days 7 hours ago

Aetna Inc.

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Case Manager Registered Nurse Aetna Inc. - Allentown, PA, United States

   

Location: Allentown, PA

Company Profile:
Aetna Inc. operates as a diversified health care benefits company in the United States. The company operates in three segments: Health Care, Group Insurance, and Large Case Pensions. The Health Care segment provides medical, pharmacy benefit management, dental, behavioral health, and vision plans on an insured basis, and an employer-funded or administrative basis. This segment also provides Medicare and Medicaid products and services, as well as other medical products, such as medical management and data analytics services, medical stop loss insurance, workers' compensation administrative services, and products that provide access to its provider networks in select markets. This segment offers its products and services to multi-site national, mid-sized, and small employers, as well as individual customers. The Group Insurance segment provides life insurance products comprising group term life insurance, voluntary spouse and dependent term life insurance, group universal life, and accidental death and dismemberment insurance; disability insurance products; and long-term care insurance products, which offer benefits to cover the cost of care in private home settings, adult day care, assisted living, or nursing facilities. This segment provides insurance products principally to employers that sponsor its products for the benefit of their employees and their employees’ dependents. The Large Case Pensions segment manages various retirement products, including pension and annuity products for tax-qualified pension plans. The company’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups, and expatriates. Aetna Inc. was founded in 1853 and is headquartered in Hartford, Connecticut.