Aetna Case Management Coordinator - Central Virginia Region (VA MCD) in Richmond, Virginia
Req ID: 46051BR
The Case Management Coordinator 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. Please note that this position requires routine and frequent field based travel in the central Virginia region.
Fundamental Components of the Case Management Coordinator role include, but are not limited to:
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.
Managed Care experience preferred
Case management and discharge planning experience preferred
Minimum of 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus required
Computer literacy and demonstrated proficiency with MS Office Suite and strong keyboard navigation skills are required
Minimum of a Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or relevant/related human services preferred (psychology, social work, marriage and family therapy, counseling)
The minimum level of education desired for candidates in this position is a Bachelor's degree in a relevant academic area (for example: Social Work, Psychology, Human Services).
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years
Functional - Medical Management/Medical Management - Case Management/1-3 Years
Functional - Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/1-3 Years
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Understanding Clinical Impacts/FOUNDATION
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Encouraging Wellness and Prevention/ADVANCED
General Business/Communicating for Impact/FOUNDATION
WAH may be available following successful completion of office based training and period of demonstrated performance in the role. Recruiter, please confirm with hiring manager protocol that must be met before moving to WAH. Core hours Monday through Friday 8-5.
ADDITIONAL JOB INFORMATION
Case management and discharge planning experience preferred 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus Managed Care experience highly desired Education and Licensure Requirements- -Minimum of a Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or relevant/related human services preferred (psychology, social work, marriage and family therapy, counseling). Ability to travel with personal vehicle to member locations. Must have dependable transportation, proof of insurance and valid VA drivers license.
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.
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Job Function: Health Care