Job Description50 - 75% Travel required in Northern Cook and Lake Counties of IL; Work from home flexible, standard business hours 8am - 5pmClinical BH Case Manager will perform the following:Care coordination involves assessing LTC members with their needs specific to transition from Nursing home to community, and developing and implementing a plan to meet those needs. Care coordination can involve setting up a schedule for the member's medications, treatments, and health care provider vi...

Job DescriptionThis is a full time teleworker position in Ohio. The Manager of Clinical Health Services leads the OhioRISE Care Plan Reviewer team and is responsible for oversight and management of clinical team processes including the organization and development of a high performing team. Must reside in Ohio. Travel will be required in-state up to 15% of the time.Fundamental Components:* Reinforces clinical philosophy, programs, policies and procedures.* Communicates strategic plan and s...

Job DescriptionAs a Clinical Case Manager you will facilitate appropriate healthcare outcomes for our members by providing care coordination, support and education for members through the use of care management tools and resources.Travel: 50-75% required in Winnebago and surrounding areas.Evaluation of Members:* Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case re...

Job DescriptionThis position requires 50-75% travel in Franklin, Union, Delaware, Pickaway, and Madison counties in OhioIn this role you will develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical covera...

Job DescriptionThis position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.This is a work at home position and all training is virtual.Enhancement of Medical Appropriateness and Quality of Care:* Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member's needs to...

Job DescriptionThis position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.This is a work at home position and all training is virtual.Enhancement of Medical Appropriateness and Quality of Care:* Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member's needs to...

Job DescriptionThis position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.This is a work at home position and all training is virtual.Enhancement of Medical Appropriateness and Quality of Care:* Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member's needs to...

Job DescriptionThis position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.This is a work at home position and all training is virtual.Enhancement of Medical Appropriateness and Quality of Care:* Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member's needs to...