POSITION SUMMARY 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 coverage and polices. Fundamental Components: Fundamental Components include, but are not limited to: Reinforces clinical programs...

Req ID: 57430BR Opportunity is open across the US and not location specific and we are willing to consider applicants based on location and full time work from home. Position Summary: The National DSNP Program Office supports DSNP growth, expansion, strategy, clinical & administrative operations for all DSNPs. This position is focused on strategic alignment of clinical initiatives; identifying opportunities to enhance capabilities to manage clinically and socially complex dually eligi...

Req ID: 58267BR POSITION SUMMARY Experienced candidates will be accountable for Product Management & Implementation following SAFe execution methodologies. Candidates will have responsibility for setting the Care/Case Management product roadmap and oversight for technology enablement post design/definition sprint activities preparing the clinical platform for migration activities. Fundamental Components: Maintain mastery-level understanding of Aetna/Clinical CM/UM workflows/processes, a...

Req ID: 57857BR POSITION SUMMARY This is an office-based position in Denver, CO. The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Fundamental Components: Fundamental Components include but are not limited: - Through the use of clinical tools and information/data r...

POSITION SUMMARY Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. Fundamental Components: Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members needs/eligibility and recommends an approach ...

POSITION SUMMARY As a Care Manager, you will help support the Amazon In Touch Care Premier Dedicated team to provide comprehensive coordination of medical services for the membership. Fundamental Components: This is an in-office Care Manager position in the San Antonio office. This position is in an office environment using a computer station and may require sitting for extended periods of time. Candidates must possess good computer skills. This position is ideal for Registered Nurses s...

Req ID: 58030BRJOIN OUR GROWING TEAMDo you want to make a difference as a Field Case Manager in your local community?Let us show you how you can expand your professional experience as a CCM, CRRN, COHN, and CDMS.We are seeking self-motivated,energetic, detail oriented, highly organized, tech-savvy Registered Nurses to join our Workers Compensation Field Case Management team. This opportunity offers a competitive salary, full benefits, and a performance-based bonus paid out on a monthly or qua...

Req ID: 58264BRPOSITION SUMMARYOffice-based position located in San Antonio, TX.The Case Manager 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.Fundamental Components:The Nurse Case Manager, utilizing advanced clinical judgment and critical thinking skills, is responsible for telephonica...

Req ID: 57702BRThis position will cover Charlottesville, Harrisonburg, Staunton, and Waynesboro, VA area.Position SummaryNurse Case Manager is responsible for assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical and disability needs of the member to facilitate the members overall wellness and appropriate and timely return to work. In doing this the NCM develops a proactive course of action to address issues presented to enhance...

POSITION SUMMARY Utilizes advanced clinical judgment, and critical thinking skills, to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Fundamental Components: Assessment of Members: - Through the use of clinical tools and information/data re...