This is an on-site position. Telephonic Case Manager 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 and timely return to work. Acts as a liaison with patient/family, employer, provider(s), insurance companies, and healthcare personnel.
Fundamental Components: -Works telephonically with workers' compensation patients, employers, providers, and claims adjusters to coordinate and assure proper delivery and oversight of medical and disability services. -Performs pre-certification process for prescribed treatment by gathering relevant data and information through clinical interviews with the injured employee, provider(s), and the employer. -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. Background Experience: -An active and good standing RN license for Florida is required -Minimum of 3 years clinical practice experience required -Previous workers compensation and/or occupational health experience is required -Previous case management 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. -Bachelor's degree in a closely-related field, or equivalent combination of education and experience. Additional Job Information: On-site position M-F. Education: Nursing - Registered Nurse Potential Telework Position: No Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. 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 for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.