Company Description
Aetna is about more than just doing a job. This is our opportunity to reshape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
Excellent benefits package, including 401k, tuition, licensure and certification reimbursement. We promote healthy & wellness lifestyles and offer specialty programs here at Aetna.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Job Overview
JOIN OUR GROWING TEAM
Are you tired of bedside nursing?
Are you looking to get away from 12-hour hospital shifts while continuing to utilize your RN expertise to impact the lives of patients in your local community?
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 quarterly basis. Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, and flexibility as you coordinate the care of your members.
Responsibilities
Responsible for assessing and analyzing an injured employee to evaluate the medical and vocational needs required to facilitate the patient’s appropriate and timely return to work.
Acts as a liaison with patient / family, employer, provider(s), insurance companies, and healthcare personnel.
TERRITORY IS SALINAS, MORGAN HILL, SANTA CRUZ, MONTEREY, SAN JOSE AND GILROY, CA
Acts as a liaison with member / client / family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members / clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members / clients telephonically or in person. May be required to meet with members / clients in their homes, work-sites, or physician's office to provide ongoing case management services.
Assesses and analyzes injured, acute, or chronically ill members / clients medical and / or vocational status; develops a plan of care to facilitate the member / client's appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimum functioning, and determination of eligibility for benefits as appropriate.
Communicates with member / client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.
Prepares all required documentation of case work activities as appropriate.
Interacts and consults with internal multidisciplinary team as indicated to help member / client maximize best health outcomes.
May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.
Provides educational and prevention information for best medical outcomes.
Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.
Testifies as required to substantiate any relevant case work or reports.
Conducts an evaluation of members / clients' needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information / data. Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. 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 / client's overall wellness through integration. Monitors member / client progress toward desired outcomes through assessment and evaluation.
All employees are expected to embody our values of Excellence, Integrity, Caring and Inspiration in all that they do as an employee. The overall responsibility of the Field Case Manager is to ensure the injured worker receives the best possible care in a timely and efficient manner towards full rehabilitation and return to work. Please note that we do offer mileage reimbursement for local travel.
Benefits and Compensation
Autonomy
Productivity incentives
Monday-Friday schedule
Reimbursement for mileage, tolls, parking, licensure and certification
Reimbursement for mileage, tolls, parking, licensure and certification
Laptop, iPhone & printer / fax / scanner all in one.
All major holidays are paid time off, vacation and sick time off is accrued. Full benefits offered including 401(k) and many corporate discounts available. Employees are reimbursed for fees to maintain licensure as well as free CEU's to maintain licensure. Continuing Education credits are available / provided for RN and a various industry certifications too. Work from home with in-state travel. In addition to annual salary, position has potential for a monthly monetary bonus.
Qualifications
License
Registered Nurse (RN) with active & unrestricted state license in good standing in the state of California where job duties are performed.
Experience
2 years clinical nursing background preferred
Prior case management and workers' compensation experience preferred
Ability to multitask in a fast paced work environment
Strong computer skills with experience in Microsoft Office Products
Excellent communication skills
MUST SPEAK SPANISH FLUENTLY
Additional Job Information
High initiative, challenging position that utilizes critical thinking and effective communication skills while working with injured workers, employers, claims examiners, attorneys, and treatment providers to improve patient outcomes.
Evaluates injured workers' medical and vocational needs to develop a specialized plan of care that promotes successful return to work while assisting in the coordination of therapeutic services. Monitors injured workers' progress toward desired outcomes in a variety of environments, including the home, work site, and physician office settings. Opportunity to make a positive impact in the life of an injured worker.
Functional Skills
Nursing - Case Management, Nursing - Disability, Nursing - Home Health Care Ambulatory Nursing, Nursing - Medical-Surgical Care, Nursing - Occupational
Technology Experience
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel
Education
Registered Nurse (RN)
Travel
Percent of Travel Required: 75 - 100%
Telework Position
Yes
EEO Statement
Aetna is an Equal Opportunity, Affiantative Action Employer
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