Aetna Clinical Case Manager in Sandy, Utah
Req ID: 46383BR
Utilizes advanced clinical judgment, and critical thinking skills, to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.
Assessment of Members: Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred members needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating members benefit plan and available internal and external programs/services.
Enhancement of Medical Appropriateness and Quality of Care: - Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits.
Monitoring, Evaluation and Documentation of Care: - In collaboration with the member and their care team develops and monitors established plans of care to meet the members goals - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
3+ years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility is required
Case management and discharge planning experience preferred
Managed care/utilization review experience preferred
Crisis intervention skills preferred
The minimum level of education desired for candidates in this position is a Master's degree.
LICENSES AND CERTIFICATIONS
Mental Health/Licensed Clinical Social Worker is required
Mental Health/Licensed Professional Counselor is required
Mental Health/Licensed Psychologist is required
Registered Nurse (RN) is required
Functional - Clinical / Medical/Disease management/1+ Years
Functional - Clinical / Medical/Concurrent review / discharge planning/1+ Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1+ Years
Technical - Desktop Tools/Microsoft Outlook/1+ Years/End User
Technical - Desktop Tools/Microsoft Word/1+ Years/End User
Technical - Aetna Applications//1+ Years/End User
Benefits Management/Encouraging Wellness and Prevention/ADVANCED
Benefits Management/Understanding Clinical Impacts/ADVANCED
General Business/Applying Reasoned Judgment/ADVANCED
General Business/Communicating for Impact/FOUNDATION
Leadership/Collaborating for Results/MASTERY
ADDITIONAL JOB INFORMATION
Candidate must be licensed in the state in which they will be working Requires knowledge of mental health and substance abuse disorders Must be able to talk on the telephone and type at the same time Experience using Motivational Interviewing and good technological skills are a plus
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