Licensed Clinical Care Manager RN for Aetna in Phoenix, AZ
Some responsibilities include:
This role is embedded in multiple clinics in Phoenix, AZ. Travel to the Aetna office in Phoenix is also required as needed.
RN license is required.
Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral health care for members through assessment and member-centered care planning. Direct provider coordination/ collaboration to promote effective utilization of available resources, optimal member functioning and cost effective outcomes.
· Through the use of clinical tools and review of member specific health information/ data, conducts comprehensive assessments of referred member’s needs in collaboration with the clinical team.
· Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address clinical indicators which impact care planning and resolution of member issues.
· Using a holistic approach consults with clinical colleagues, supervisor, medical directors and/ or other programs to overcome barriers to meeting goals and objectives.
· Ability to speak to medical and behavioral health professionals to influence appropriate member care.
· Utilizes motivational interviewing skills to ensure engagement of clinical care team in an integrative model of healthcare service delivery.
· Provides coaching, information and support to the clinical care team.
· Analyzes all utilization and clinical data available to consolidate information and begin to identify comprehensive member needs.
· In collaboration with the clinical care team, develops and monitors care plans to meet the member’s goals.
· Adheres to care management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
· Identifies and escalates quality of care issues through established channels.
3-5 years clinical practice experience, e.g. mental health clinic, hospital setting, alternative care setting such as home health or ambulatory care is required.
Case management and discharge planning experience is highly preferred
Managed Care experience is preferred
Crisis intervention skills is preferred
Must be a Registered Nurse
The highest level of education desired for candidates in this position is a Bachelor’s degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN)
Discharge planning/1-3 Years
Managed Care/Insurance Clinical Staff/1-3 Years
Case Management/1-3 Years
Disease management/1-3 Years
Nursing/Mental Health/1-3 Years
Desktop Tools/Microsoft Outlook/1-3 Years
Considered a mobile position. Job is embedded in the PNO clinic site. Potential for work at home approximately 8 hrs per week. Must come to office for meetings, trainings, supervision.
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