Aetna Special Needs Coordinator in Philadelphia, Pennsylvania
Req ID: 45560BR
Responsible for contacting members, parents and/or guardians, Primary Care Providers, and/or other care team members to assess the medical and/or social risks of special needs members. Responsible for completing the clinical and social assessment of members and determining the need for clinical and/or community case management
Responsible for reviewing state and/or health plan reports identifying members that are classified as special needs. Initiates the first level of clinical and social assessment.
Initiates communication with the members Primary Care Provider, Department of Family Services Case Worker, School Nurse, and/or specialist provider as necessary to assess the clinical and/or social needs of the special needs member and refer to case management as appropriate.
Completes accurate case documentation; indicates referral to clinical and/or social case management, documents care plans, interventions, goals met, closure of case and/or inability to contact member and/or parent/guardian based on standard company polices.
Communicates cases to management where contact has not been achieved; seeks additional direction and guidance if necessary.
Works with health plan management to develop and maintain the plans community resource manual.
Develops and presents informational reports on the special needs members based on member enrollment, utilization of service(s) and/or case management outcomes.
May participate in state directed meetings and/or in-services to provide care and coordination of care for the special needs population.
Performs other duties as required.
Exhibits the following Manager Behaviors
LPN, RN, LSW, LCSW, or LPC with active state license in good standing in the state of Pennsylvania required
3+ years of experience working with a special needs population is required
Public speaking and presentation skills are required
Strong verbal and written communication skills are strongly preferred
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Flexible telework, will be required to be in office for certain meetings, etc.
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
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.
Job Function: Health Care