Oct 20, 2019

Precertification Nurse (RN)

  • Professional Diversity Network
  • High Point, NC, USA
Full-Time Other

Job Description


Description: This role is office based in High Point, NC.
The required hours are Monday-Friday 8:00am-4:30pm EST with occasional evening shift rotation until 8pm.

The Clinical Services Advocate is part of a dedicated team of clinical and service professionals empowered to take care of all aspects of a member's health. Clinical Services Advocates are responsible for providing personalized, end to end member support including coordination of health care services, decision support, benefits support, complex case management and chronic condition management. Clinical Service Advocates serve as a single point of contact to help the provider, member and family maximize benefits and easily navigate the health care system. The Clinical Advocate provides the member and provider community with a powerful and proactive experience through high touch, personalized communications designed to help the member achieve their health ambition in collaboration with the provider.


Fundamental Components: -Facilitate the ongoing coordination and delivery of health care services to enhance a member's health, wellness and achieve quality outcomes.
-Effectively engage members using omni-channel communication mechanisms (phone,email, chat, text, IM).
-Develop a personalized plan with member based on their health ambition and communication preferences.
-Serve as single point of contact for the member and enrolled family.
-Assist with effective use of health care benefits, access to available programs/services and determining next best actions to achieve health ambitions.
-Conduct proactive outreach to at risk members and leverage available data to identify actionable health needs.
-Holistically assess member's needs and collaborate with treating providers, vendor partners and other Advocate team members to formulate care plans and coordinate services.
-Develop personalized, creative solutions to help member's meet their health care needs.
-Assist members to prioritize health goals to achieve positive outcomes and health ambitions.
-Build strong, trusting relationships by fully understanding the member's needs and goals Background Experience: -RN with current, unrestricted licensure in state in which work is being done required
-3+ years of clinical practice experience required
-Experience in case management, discharge planning and/or home health care preferred
-Willingness to obtain RN licensure in other states as needed
-BSN or equivalent experience required
-Bilingual language skills preferred but not required
Additional Job Information: Demonstrates highly developed communication and people skills. Ability to engage and interact easily with diverse group of individuals. Strong listener, empathetic and supporting. *Ability to prioritize and multitask in fast paced, deadline driven environment. *Ability to adapt to constantly changing demands and environment. *Demonstrates a commitment to service; accountable for actions and issues resolution, responsive to customer needs. *Team player - collaborates with co-workers and vendor partners to deliver best in class service. *Demonstrates strong problem solving skills and ability to work independently. *Requires proficiency with computer skills including keyboarding, navigating multiple systems. *Proficiency in use of Microsoft Outlook and Office. *Must be able to work in office setting with extended periods of time sitting, talking on telephone and typing on computer. Required Skills: Benefits Management - Understanding Clinical Impacts, General Business - Applying Reasoned Judgment, Leadership - Driving Strategic and Organizational Agility Desired Skills: General Business - Communicating for Impact, Leadership - Collaborating for Results, Leadership - Driving Change Functional Skills: Clinical / Medical - Precertification, Communication - Member communications Technology Experience: Aetna Application - Aetna Total clinical View, Desktop Tool - Microsoft Outlook Education: Nursing - Certified Case Manager (CCM), Nursing - Registered Nurse (RN) 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.





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