Sr. Disease Manager, RN

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JOB MISSION SUMMARY
This position is responsible for the planning, development, implementation, and timely oversight of assessments, development of care plans, interventions, and educational materials for members with chronic conditions. The incumbent is responsible for managing disease management processes as defined by NCQA, which includes improving coordination, continuity, accessibility, and appropriate utilization of health care services and community resources for members with chronic conditions.

RESPONSIBILITIES:
- Obtains verbal consent of the member for participation in the disease management program for all plans.
- Identifies problems, sets goals, determines interventions, and the members health status based on assessment.
- Conducts telephone interviews of members to identify risk factors and the need for disease management.
- Initiates, develops, plans and implements care plans designed to promote the delivery of quality care and services to comply with regulatory requirements.
- Communicates with primary care and/or treating physician to request specific health information and/or to provide an update of an individual s health care status.
- Transfers members needing more intensive management to case management, as indicated.
- Performs follow-up on established care plan events and makes contact with the member in the disease management program, as appropriate.
- Understands the benefits and restrictions of each plans specific requirements as related to disease management.
- Documents in disease management software system member-specific assessments, education and outreach efforts consistent with regulatory and corporate requirements.
- Prepares reports and case summaries as needed.
- Completes special assignments and projects instrumental to the function of the department. Works in conjunction with operational functions regarding clerical staff.
- Utilizes clinical judgment to discharge members from disease management according to appropriate policies and procedures.
- Educates members' medical providers regarding the members' progress in the program.
- Coordinates, communicates, and refers members to community support and/or social service systems, as required.
- Understands the identification process of high risk, high cost, impactable members and utilizes this predictive modeling tool to assist in the selection of potential disease managed members.
- Assists with special projects to meet change and departmental goals.

Required Skills:
REQUIRED SKILLS
- The ability to successfully utilize Microsoft Office suite (Word, Excel, and PowerPoint).
- Effective written and oral communication skills to include presentations and training before small and large groups.
- Effective problem solving, organizational and time management skills with the ability to consistently work in a fast-paced environment.
- Bi-lingual (Spanish) preferred.

ADDITIONAL JOB INFORMATION
- Registered Nurse with BSN preferred.
- Minimum of two years of case/disease management experience.
- Minimum two years managed care experience preferred.
- Written report preparation (such as Excel), and critical thinking skills are required.
- Maintains a high level of professionalism at all times.
- Ability to type 45 words per minute/net.
- Must have own reliable transportation with appropriate insurance.

At Aetna, we value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with Aetna.

How to apply

To learn more about this opportunity, visit us at www.schalleranderson.com Under requisition # select 22017 and submit your resume.

We conduct pre-employment drug screening and background checks.
No agencies, please.

Aetna is an equal opportunity/affirmative action employer.