Aetna Case Management Coordinator - KS MCD - 52060BR in Wellington, Kansas
Req ID: 52060BR
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of case and utilization management, quality management, network management and clinical coverage and policies. Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
Routine field-based travel with personal vehicle is a job requirement. Qualified candidates must have dependable transportation, valid KS state driver s license and proof of vehicle insurance
Evaluation of Members:
Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
Coordinates and implements assigned care plan activities and monitors care plan progress.
Enhancement of Medical Appropriateness and Quality of Care:
Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs 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 members benefits and/or healthcare needs.
Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
Helps member actively and knowledgably participate with their provider in healthcare decision-making.
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.
Minimum requirement of a Bachelor's degree OR non-licensed Master's level clinician, with either degree being in Behavioral Health or other relevant Human Services field (e.g., Social Work, Psychology, Counseling, or Marriage and Family Therapy); licensed Bachelor's or licensed Master's level clinicians may also apply (LBSW, LPC, LMSW, LAC, LMFT, etc.).
Minimum 2 years experience in Behavioral Health, Social Services or appropriate related field equivalent to program focus is required.
Long Term Services and Support (LTSS) experience is required.
Proficiency with computer technology is required.
Knowledge of community resources and provider networks is required.
Previous experience conducting face-to-face care management is a plus; qualified candidates must have the ability to support the complexity of members needs including face-to-face visitation.
Ability to multitask, prioritize, and effectively adapt to a fast paced changing environment is required.
Strong documentation skills are required.
Ability to work independently and on a team is required.
Strong communication skills (written and oral) are required.
Strong organizational skills are required.
Managed Care experience is strongly preferred.
Intellectual or Developmental Disabilities (IDD) experience strongly preferred.
Case management and discharge planning experience.
Experience and knowledge in clinical guidelines, systems and tools i.e. Milliman, Interqual.
Familiarity with local health care delivery systems.
Behavioral Health experience.
Minimum requirement of a Bachelor's degree OR Master's degree with either degree being in Behavioral Health or other relevant Human Services field (e.g. Psychology, Social Work, Marriage and Family Therapy, Addiction Counseling, Counseling, etc.).
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Position is office-based now. Telework may commence following successful completion of on-boarding, training and demonstrated attendance and performance with assigned caseload. In our experience, the time frame for telework commencement may vary.
ADDITIONAL JOB INFORMATION
Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Kansas is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you ll join a team dedicated to improving the lives of KanCare members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Kansas, and we will support you all the way.
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