Aetna Better Health of West Virginia is offering a $3,000 sign-on bonus for this position.
ABHWV is looking for talented, service oriented individuals to lead innovation within the new WV Foster Care program. As a Care Manager, you will receive training in an approach to foster care that ensures children can be safe at home with their families surrounded by responsive communities. You will join care teams that design creative and responsive plans for children and families resulting in much shorter lengths of stay, the attainment of goals and children being kept safe and thriving. You will have colleagues who will join you in this work who bring their specific expertise and passion for services that are effective and rewarding. You will enjoy rewarding work that produces positive outcomes based on models of care proven to keep families together while fostering healing.
The Case Manager RN is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. 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 member’s overall wellness through integration. Services, strategies, policies and programs are comprised of network management and clinical coverage policies.
Routine field-based travel in Eastern WV with personal vehicle is a job requirement. Qualified candidates must have dependable transportation, valid state driver’s license and proof of vehicle insurance.
Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
Assessments will take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
Reviews prior claims to address potential impact on current case management and eligibility.
Assessments will include the member’s level of work capacity and related restrictions/limitations.
Application and interpretation of disability criteria and guidelines, applicable policies and procedures, regulatory standards and disability benefit plan to determine eligibility and integration with available internal/external programs.
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 interviewing skills to ensure maximum member engagement in disability process and a timely RTW.
RN with current unrestricted WV state licensure required.
3+ years’ clinical practice experience required.
Knowledge of community resources and provider networks required.
Familiarity with local health care delivery systems required.
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.
Availability to work a rotational on-call schedule required.
Case management and discharge planning experience preferred.
Managed Care experience preferred.
Crisis intervention skills preferred.
Behavioral Health experience is a plus.
Background and experience strongly desired:
Experience with youth and foster populations.
Crisis intervention skills.
Favorable attitude toward families; comfortable being a change agent for families.
Previous experience traveling and making home visits.
Experience with trauma informed care.
Knowledge of opioid misuse and addiction.
Familiarity with the Family First Prevention Services Act.
Additional Job Information:
Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of West Virginia is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of West Virginia, and we will support you all the way.
Required Skills: Finance - Managing Aetnas Risk, General Business - Applying Reasoned Judgment
Desired Skills: General Business - Consulting for Solutions, Leadership - Collaborating for Results, Leadership - Fostering a Global Perspective
Functional Skills: Clinical / Medical - Direct patient care (hospital, private practice), Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Direct patient care
Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel
Education: Nursing - Registered Nurse (RN)
Potential Telework Position: Yes
Percent of Travel Required: 25 - 50%
EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer
Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this 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.
Aetna's mission is to build a healthier world by helping people realize their ambitions and achieve their goals, one person and one community at a time. We are a leading diversified health care benefits company that is helping to transform health care by providing and advancing the information, tools and resources people need to achieve their best possible health.
Our team of nearly 50,000 employees serves an estimated 37 million people and is committed to giving them a better health care experience while providing access to affordable, high-quality health care. Our digital tools and online resources help guide members on their health care journey. And our people are empowered, innovative and supported at every step of their own career journey. Our strength as a company enables us to deliver greater value and well-being opportunities to consumers, and bigger challenges, rewards and career opportunities for our employees. Join us and help turn health ambitions into achievements - big and small.