Aetna Social Worker - 44944BR in Fort Myers, Florida

Req ID: 44944BR

Position Summary:

The Social Worker, within a inter-disciplinary care team setting, is responsible to support member-centered care management across the health care continuum, working with the care team, members and their families, assessing social and behavioral health needs, addressing the social determinants of health, actively participating in the members plan of care to promote effective utilization of plan benefits, available resources, optimal member functioning, and cost-effective outcomes.

Additional Job Responsibilities:

  • Assessment of members through use of clinical tools/review of member-specific health information/data

  • Conducts comprehensive assessments of referred members needs/eligibility and in collaboration with the members care team, determines an approach to resolve member issues/meeting needs by evaluating the members benefit plan & available internal and external programs/services/resources

  • Applies clinical judgment to incorporate strategies designed to reduce risk factors & barriers; address clinical indicators & barriers which impact care planning/resolution of member issues

  • Using advanced clinical skills, prioritizes members experiencing acute behavioral health/medical issues & refers to the appropriate clinical/service providers for thorough assessment & treatment

  • Conducts at-home assessments & consultations with members/families

  • Provides crisis follow up to members and their families to ensure they are receiving the appropriate treatment/services

  • Using a holistic approach consults with clinical colleagues, supervisors, Medical Directors, & other programs to overcome barriers to meeting goals/objectives. Presents cases at case rounds/conferences to obtain a multidisciplinary perspective and recommendations.

  • Identifies/escalates member safety & quality of care issues through established channels.

  • Collaborates w/medical & behavioral health professionals to coordinate member care.

  • Utilizes influencing/motivational interviewing skills to ensure maximum member engagement; promotes lifestyle/behavior changes to achieve optimum level of health.

  • Provides coaching, information and support to empower the member to make ongoing independent medical/healthy lifestyle choices.

  • Helps member actively & knowledgeably participate w/their provider in healthcare decision-making.

  • Utilizes negotiation skills to secure appropriate options & services necessary to meet the members benefits/healthcare needs.

  • In collaboration with the member & care team, develops & monitors established plans of care to meet the members goals. Adheres to care management requirements

  • Consults w/care team/other appropriate programs/resources to overcome barriers to meeting goals & objectives; presents cases to appropriate resources to obtain multidisciplinary view in order to achieve optimal outcomes.

  • Maintains a comprehensive working knowledge of community resources, payer requirements and network services

Background/Experience desired:

  • 3+ years clinical practice experience, e.g., community, public health, hospital setting, alternative care setting such as home health or ambulatory care required

  • Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications

  • Ability to travel within a designated geographic area required

  • Case management, behavioral health, discharge planning experience preferred

  • Managed Care, Medicare/Medicaid experience preferred

  • Crisis intervention skills preferred

  • Bilingual (Spanish, Creole and/or Vietnamese) preferred

Education:

  • The minimum level of education required for candidates in this position is a Master's degree

Licenses and Certifications:

  • Licensed Clinical Social Worker (LCSW), active and in good standing

Telework Specifications:

  • This is a work from home position, but the successfulcandidate will be responsible for traveling within one of the below listedgeographical areas:

  • Miami-Dade, Broward

  • Palm Beach, Martin, Hendry

  • Saint Lucie, Brevard, Osceola, Indian River

  • Orange, Seminole, Volusia, Lake

  • Lee, Collier, Monroe

  • Sarasota, Manatee, Charlotte, Desoto

  • Pinellas, Hillsborough, Polk, Pasco, Hernando

  • Duval, Saint Johns, Clay, Nassau, Baker

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.

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Job Function: Health Care