At Aetna Better Health of Texas, we are committed to helping people on their
path to better health. By taking a total and connected approach to health, we
guide and support our members so they can get more out of life, every day. We
are 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 Texas STAR Kids members. We value diversity and are dedicated to
helping you achieve your career goals.
The Transition Coordinator 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.
This position requires routine travel in the Dallas service area, 70-80% of
the time. Some travel to the Dallas office, support location, may also be
required. Use of personal vehicle when traveling in the field; must have
active and valid TX driver’s license, reliable transportation and vehicle
insurance. Business mileage is eligible for reimbursement, in accordance with
travel policy guidelines. Candidates may reside in any of these or adjacent
counties: Collin, Dallas, Ellis, Hurt, Kaufman, Navarro, and Rockwall.
* 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. Assessments include the member’s level of work capacity and related restrictions/limitations.
* Using a 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.
* Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
* Works collaboratively with member and their social supports to develop and implement a service plan specific to transitioning members from pediatric to adult care holistically.
* Ensures successful transition from pediatric to adult care and MCO.
* RUB certified RN; or ability to complete RUG certification within 60 days of start date is required.
* 5 years clinical practice experience RN with current unrestricted state licensure required.
* Case Management in an integrated model preferred.
* Pediatric/Adolescent experience preferred
* Bilingual preferred.
Additional Job Details:
* Typical office working environment with productivity and quality expectations
* Work requires the ability to perform close inspection of handwritten and 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
* Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel. Strong keyboard and mouse skills required.
* Effective communication skills, both verbal and written.
Additional Job Information:
Typical office working environment with productivity and quality
expectationsWork requires the ability to perform close inspection of hand
written and 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 environmentPosition requires proficiency with computer skills
which includes navigating multiple systems and keyboardingEffective
communication skills, both verbal and written.
Potential Telework Position:
Percent of Travel Required:
75 – 100%
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.