天津招聘

职位描述：

Family Summary/Mission
Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits whilepromoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs thatensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.
Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.

Position Summary/Mission
Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case
management activities with members to evaluate the medical and disability needs of the member to facilitate the
member’s overall wellness and appropriate and timely return to work. In doing this the NCM develops a proactive courseof action to address issues presented to enhance the short and long term outcomes as well as opportunities to enhance amember’s overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.

Fundamental Components & Physical Requirements include but are not limited to (* denotes essential functions)
? Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit
plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
? Assessments will take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
? Reviews prior claims to address potential impact on current case management and eligibility.
? Assessments will include the member’s level of work capacity and related restrictions/limitations.
? Application and interpretation of disability criteria and guidelines, applicable policies and procedures, regulatorystandards and disability benefit plan to determine eligibility and integration with available internal/external programs.
? Using holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
? Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case
conferences for multidisciplinary focus to benefit overall claim management.
? Utilizes case management processes in compliance with regulatory and company policies and procedures.
? Supports, integrates and executes the IHD process.
? Utilizes assessment techniques to assess for integration opportunities and determining work capacity.
? Utilizes l interviewing skills to ensure maximum member engagement in disability process and a timely RTW.
? Exhibits the following Case Manager Behaviors

Background/Experience Desired
? 5 years clinical practice experience
? Bilingual preferred
? Disability case management experience preferred

Education and Certification Requirements
RN with current unrestricted state licensure required.

Additional Information (situational competencies, skills, work location requirements, etc.)
? Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
? Effective communication skills, both verbal and written.
? Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
? Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
? Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
? Typical office working environment with productivity and quality expectations

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安态（上海）企业服务有限公司是美国安泰集团在中国的全资子公司。美国安泰集团公司（纽约证券交易所代号: AET，以下简称安泰集团） 始创于1853年，全球总部位于美国康涅狄格州哈特福德市，是美国历史最悠久的金融保险集团之一，也是全球财富500强企业，2010年营业收入超过342亿美金。

跨入21世纪，安泰集团已发展成为国际领先的专业健康福利保障公司，业务范围涵盖健康保险产品及相关服务，其中包括医疗、药物、牙科、行为健康、团体人寿和伤残计划，以及针对公共医疗补助计划的医疗管理功能和保健管理服务。

安泰集团在全球聘用了超过35000名员工，包括执业医师、护士、药剂师及其他临床专业人士。作为健康福利保障业的翘楚，我们的客户包括员工团体、个人、大学学生、***和小时工、健康计划、资助计划、劳工组织及外籍人员。

2008年3月，安泰集团被美国财富杂志推选为美国最值得推崇的健康福利保障公司。同年，安泰集团也被美国商业周刊杂志推选为最适合开展职业生涯的公司之一。

安态（上海）企业服务有限公司致力引进美国先进的健康管理理念与技术，为中国市场企业客户提供高质量的健康管理服务和健康保险外包服务。

更多信息，请登陆公司网站：
www.aetna.com

Aetna (Shanghai) Enterprise Services Co. Ltd is a wholly owned enterprise of Aetna Inc. Aetna (NYSE: AET) was established in 1853 with headquarter in Hartford, CT, USA. As a global Fortune 500 company, Aetna is a well-known finance – insurance group in the US. Its 2010 revenue exceeded USD 34.2 billion.

Entering into the 21st century, Aetna now is a leading provider of health and related benefits programs, covering health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans.

Aetna has over 35,000 employees worldwide, including licensed physicians, nurses, pharmacists and other clinic staff. Being the leading health-related benefit provider, Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates.

In 2008, Aetna was ranked 1st in Fortune's 2008 Most Admired Health Care Company and was also recognized as one of the "Best Places to Launch a Career" in 2008 by Business Week.

Aetna (Shanghai) Enterprise Services Co. Ltd aims to introduce international concepts and practice of health management services into China to provide high quality health management services.

For more information, please visit our website:
www.aetnainternational.com