New Haven, CT, United States
Healthcare, Case Management, Manager, Nursing
Req ID: 60964BR
This role sits onsite in New Haven, CT and requires standard business hours Monday-Friday.
Responsible for telephonically assessing, planning, implementing and coordinating all case management activities associated with an injured employee to evaluate the medical and disability needs of an injured worker and facilitate the patient’s appropriate medical treatment. Works closely with the claims staff as a clinical consultant.
Fundamental Components included but are not limited to:
Works telephonically with workers’ compensation patients, employers, providers, and claims adjusters to coordinate and assure proper delivery and oversight of medical and disability services. Evaluates and coordinates medical and rehabilitative services using cost containment strategies. Plans a proactive course of action to address issues presented to enhance the injured employee’s short and long-term outcomes. Assesses and identifies barriers to recovery; determines goals, objectives, and potential alternatives to care. Works as an advocate to promote the injured employee’s best interest, addressing treatment alternatives, coordination of quality, cost effective health care and rehabilitative services. Assists the injured employee by providing medical and disability education and coordinating on-site job analysis, work conditioning, functional capacities, and ergonomic evaluations. Negotiates and assists employers with the development of transitional sedentary or modified job duties based on the injured employee’s functional capacity to ensure the injured employee’s safe and timely return to work. Monitors, evaluates, and documents case management activities and outcomes including, but not limited to, case management approaches, over or under utilization, inappropriate care, effective treatment, permanent or temporary loss of function, failed or premature return to work, and non-compliance. Adheres to all appropriate privacy, security and confidentiality policies and procedures. Performs other duties as assigned.
Qualifications Requirements and Preferences:
Registered Nurse (RN) with active state license in good standing is required
3 years of clinical practice experience required
Prior case management experience is required
Previous workers compensation, utilization review, or managed care experience preferred
Strong analytical skills used to identify and resolve problems
Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) preferred, but not required
Effective communications, organizational, and interpersonal skills.
Nursing - Registered Nurse
Nursing - Case Management
Additional Job Information:
Work on-site with the claims team to be a clinical resource for consultation.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Workers' Compensation
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.
Website : http://www.aetna.com
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