Case Manager / 个案诊疗经理（高端医疗险）
安态（上海）企业服务有限公司
- 公司规模：150-500人
- 公司性质：外资(欧美)
- 公司行业：保险
职位信息
- 发布日期：2013-07-11
- 工作地点：上海-黄浦区
- 招聘人数：1
- 工作经验：三年以上
- 学历要求：本科
- 语言要求：英语熟练
- 职位类别：保险内勤 护理主任/护士长
职位描述
Position Summary/Mission:
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Fundamental Components & Physical Requirements:
? Assessment of Members/Claimants:
- Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
? Enhancement of Medical Appropriateness & Quality of Care:
- Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits
- Using holistic approach consults with supervisors , Medical Directors and/or others to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes
- Identifies and escalates quality of care issues through established channels
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
? Monitoring, Evaluation and Documentation of Care:
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
Background/Experience Desired:
? 3 - 5 years hospital setting experiences
? With Discharge Planning/case management skills are preferred: assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate inpatient healthcare management and effective discharge planning to improve outcomes for patients.
? More than one year worked as a clinical nurse or doctor
? Healthcare and/or managed care industry experience
Educational Requirements:
? Educated to degree level
? Clinically trained with Degree or recognised designation in western Medicine / Nursing or other western medical disciplines
Language Requirements:
? Fluent in verbal and written English
? Mother tongue: Mandarin
The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
Fundamental Components & Physical Requirements:
? Assessment of Members/Claimants:
- Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
? Enhancement of Medical Appropriateness & Quality of Care:
- Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits
- Using holistic approach consults with supervisors , Medical Directors and/or others to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes
- Identifies and escalates quality of care issues through established channels
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
? Monitoring, Evaluation and Documentation of Care:
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
Background/Experience Desired:
? 3 - 5 years hospital setting experiences
? With Discharge Planning/case management skills are preferred: assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate inpatient healthcare management and effective discharge planning to improve outcomes for patients.
? More than one year worked as a clinical nurse or doctor
? Healthcare and/or managed care industry experience
Educational Requirements:
? Educated to degree level
? Clinically trained with Degree or recognised designation in western Medicine / Nursing or other western medical disciplines
Language Requirements:
? Fluent in verbal and written English
? Mother tongue: Mandarin
公司介绍
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
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
联系方式
- 公司地址：地址：span蒙自路757号