Aetna Licensed Clinical Care Manager (CA MCD) in W. Sacramento, California
Req ID: 44411BR
Positions are located in Sacramento, CA. and require frequent and routine field travel with personal vehicle to member locations. The Clinical Care Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members through assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes.
Assessment of Members: -Through the use of clinical tools and 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 resolving member issues and/or meeting needs by evaluating the members benefit plan and available internal and external programs/services and resources. - Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex clinical indicators which impact care planning and resolution of member issues. - Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical and service providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services. -Enhancement of Medical Appropriateness and Quality of Care -Monitoring, Evaluation and Documentation of Care Certified Case Managers are a plus.
BACKGROUND/EXPERIENCE:3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care; Required.Case Management, Discharge planning and Behavioral Health experience; Strongly PreferredManaged Care experience; PreferredCrisis intervention skills; PreferredEDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
One of these 3 licenses is required.
Nursing/Registered Nurse is desired
Mental Health/Licensed Clinical Social Worker is desired
Mental Health/Licensed Professional Counselor is desired
Mental Health/Licensed Psychologist is desired
Functional - Medical Management/Medical Management - Case Management/4-6 Years
Functional - Medical Management/Medical Management - Discharge planning/4-6 Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years
Functional - Medical Management/Medical Management - Direct patient care/4-6 Years
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User
These positions are based in office in W. Sacremento and will require local travel within that county.
ADDITIONAL JOB INFORMATION
Additional background and experience desired: 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 Computer literacy and proficiency with Microsoft Excel, Word, including navigating multiple systems and keyboarding Ability to multitask, prioritize and effectively adapt to a fast paced changing environment Knowledge of community resources and provider networks Familiarity with local health care delivery systems Behavioral Health experience is a plus Strong documentation skills Ability to work independently and as part of a team Strong communication skills, written and oral Strong organizational skills. Ability to travel in the field required with personal vehicle. Must possess active/valid CA driver's license and proof of insurance. Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of California is looking for people like you who value excellence, integrity, caring and innovation. As an employee, youll join a team dedicated to improving the lives of the most vulnerable in our population. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of California, 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.
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Job Function: Health Care