Registered Nurse (RN) - Medicare Case Manager
Aetna - Portland, ME

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Req ID: 13375BR

Past experience working in Medicare or with geriatric patients is highly preferred. The candidate's background ideally will include nursing experience in acute medical surgical along with home care/hospice experience and discharge planning.In order to be considered, candidates must live within commuting distance to Aetna's Hartford CT, Blue Bell PA, or Tampa FL offices. Candidates who reside in commuting distance to the South Portland, ME office, you will be working from home directly after the first day of onboarding in the South Portland office.POSITION SUMMARYThe Case Manager RN Medicare utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. The CM process includes: assessing the member's health status and care coordination needs, inpatient review and discharge planning, developing and implementing the case management plan, ongoing evaluation of the case plan with Medical Director involvement as indicated and case closure when closure criteria achieved.Experience in case management, home care and/or sub-acute nursing preferred. Current Case Management certification is a plus. Good time management and organizational skills along with the ability to manage continually changing priorities are needed. The ideal candidate must have excellent written and verbal communication skills. This position requires proficiency with computers. Computer skills include navigating in multiple systems and web-based applications, use of mouse and strong keyboarding skills. Familiar with Microsoft Word and Excel; ability to copy and paste.EDUCATIONThe highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.LICENSES AND CERTIFICATIONSNursing/Certification in Geriatrics is desiredNursing/Certified Case Manager (CCM) is desiredNursing/Registered Nurse (RN) is requiredFUNCTIONAL EXPERIENCESFunctional - Nursing/Case Management/1-3 YearsFunctional - Nursing/Medical-Surgical Care/acute clinical experience/4-6 YearsFunctional - Nursing/Disease management/1-3 YearsFunctional - Nursing/Discharge Planning/1-3 YearsFunctional - Nursing/Home Care/Hospice/1-3 YearsTECHNOLOGY EXPERIENCESTechnical - Desktop Tools/Microsoft Word/1-3 YearsTechnical - Desktop Tools/Microsoft Outlook/1-3 YearsTechnical - Desktop Tools/TE Microsoft Excel/1-3 YearsTechnical - Aetna Applications/Aetna Total clinical View/1-3 YearsTechnical - Aetna Applications/TE eTUMS -Total Utilization Management System Internet/1-3 YearsREQUIRED SKILLSBenefits Management/Maximizing Healthcare QualityBenefits Management/Supporting Medical PracticeBenefits Management/Understanding Clinical ImpactsDESIRED SKILLSLeadership/Collaborating for ResultsService/Providing Solutions to Constituent NeedsGeneral Business/Turning Data into InformationPlease note that benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.

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Job Function: Health Care

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