Posted in Other 23 days ago.
This job brought to you by Professional Diversity Network, Inc
Type: Full Time
Location: Chantilly, Virginia
Description: POSITION SUMMARY
The Clinical Care 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. Please note that this position will require routine and frequent field-based travel to member locations.
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
Minimum of 3 years of clinical practice experience (hospital setting, alternative care setting such as home health, or ambulatory care) required.
The following license is required: RN (unrestricted VA state license)
Must have the ability to support the complexity of members' needs, including face-to-face visitation.
Proficiency with Microsoft Excel, Word, navigating multiple systems and keyboarding required.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment required.
Strong documentation skills required.
Ability to work both independently and as part of a team required.
Strong written and verbal communication skills required.
Strong organizational skills required.
Ability to travel in the field required (25-50% local field travel).
5 years clinical practice experience
Case Management in an integrated model preferred
Case management and discharge planning experience preferred
Managed Care experience preferred
Crisis intervention skills preferred
Knowledge of community resources and provider networks preferred
Familiarity with local health care delivery systems preferred
Behavioral Health experience preferred
Previous experience conducting face-to-face care management is preferred
Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Functional - Medical Management/Medical Management - Case Management/1-3 Years
Technical - Desktop Tools/Microsoft Explorer/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Supporting Medical Practice/FOUNDATION
Benefits Management/Understanding Clinical Impacts/FOUNDATION
Must reside in the Chantilly VA area
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 takes our candidates'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.
58868 Potential Telework Position: Yes Percent of Travel Required: 25 - 50% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer