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Aetna Inc.

Case Manager

Aetna Inc. - Jacksonville, FL

This is a telework role. The required hours are Monday-Friday 11am-7:30pm EST.

POSITION SUMMARY

The Maternity Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical and disability needs of the member to facilitate the members overall wellness and appropriate and timely return to work. In doing this the nurse develops a proactive course of action to address issues presented to enhance the short and long term outcomes as well as opportunities to enhance a members overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.

Fundamental Components include but are not limited to:

-Using holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.

-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.

-Utilizes case management processes in compliance with regulatory and company policies and procedures.

-Supports, integrates and executes the IHD process.

-Utilizes assessment techniques to assess for integration opportunities and determining work capacity.

-Utilizes l interviewing skills to ensure maximum member engagement in disability process and a timely RTW.

-Exhibits Case Manager Behaviors

BACKGROUND/EXPERIENCE

-An RN license is

required

-3 years minimum of clinical practice experience in Obstetrical Nursing is

required

-Strong technology skills are

required

-Strong communication and interpersonal skills are

required

EDUCATION

The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Registered Nurse (RN) is required

Nursing/Certificate in Obstetrics is preferred

FUNCTIONAL EXPERIENCES

Functional - Nursing/OB/GYN/4-6 Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User

REQUIRED SKILLS

Leadership/Driving a Culture of Compliance

Technology/Leveraging Technology

Telework Specifications:

Considered only for current internal teleworkers (in any area) unless there is not any space in the office near the new hire--then will consider for immediate WAH.

ADDITIONAL JOB INFORMATION

A great way to use OB skills and knowledge to help significant impact our high-risk pregnant moms

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.

13 days 9 hours ago

Aetna Inc.

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Case Manager Aetna Inc. - Jacksonville, FL, United States

   

Location: Jacksonville, FL

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.