Nurse Case Manager 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.
Onsite Dallas, TX.
Schedule is Monday-Friday standard business hours.
No nights, no weekends and no holidays! 70829
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. Applies clinical judgment to the incorporation of strategies designed
to reduce risk factors and barriers and address complex health and social
indicators which impact care planning and resolution of member issues.
Assessments 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. 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. Utilizes interviewing skills to ensure maximum member
engagement and discern their health status and health needs based on key
questions and conversation.
Requires recent RN experience in maternal health/OB/NICU.
Case Management in an integrated model preferred.
Bilingual Spanish preferred.
3 years clinical practice experience.
Proficient computer skills required
RN with current unrestricted Texas state licensure required.
Additional Job Information:
Typical office working environment with productivity and quality expectations.
Work requires the ability to perform close inspection of computer generated
documents as well as a PC monitor. Sedentary work involving periods of
sitting, talking, listening. Work requires sitting for extended periods,
talking on the telephone and typing on the computer. Ability to multitask,
prioritize and effectively adapt to a fast paced changing environment.
Position requires proficiency with computer skills which includes navigating
multiple systems and keyboarding. Effective communication skills, both verbal
Percent of Travel Required:
0 – 10%
Aetna is an Equal Opportunity, Affirmative Action Employer
Benefit eligibility may vary by 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.