Aetna Social Worker in Albany, New York
Req ID: 53641BR
Licensed Social Worker (LSW) - REQUIRED
Must be located in IL, IN, NY, or MO.
Functions as a coordinator of care for members identified as having long-term rehabilitation and/or psychosocial needs as a result of birth defects, chronic conditions, illness or injury for members to prevent exacerbations, re-admissions or need for placement into custodial care. Responsible for implementing and coordinating all case management, psychosocial, and quality of life activities relating to cases across the continuum of care including consultant referrals, home care visits, use of community resources and alternative levels of care. Responsible for developing and carrying out strategies to coordinate and integrate all acute and long-term care services to the members, and to those in case and disease management. Provides psychosocial interventions through resource identification, program development and other means. This position may specialize within a disease area and may serve in a consultative role to other health care professionals.
Responsible for the comprehensive management of members with acute or chronic conditions. Case management activities will focus on quality of care, compliance, outcomes and decreasing costs.
Responsible for developing and carrying out strategies to coordinate and integrate all acute and long-term care services to members to prevent exacerbations and/or placement of the members in custodial care.
Applies case management concepts, principles and strategies in the development of an individualized case plan for enrolled members in case or disease management that are at risk of poor outcomes. The case plan addresses the members broad spectrum of needs.
The case planning process includes the following actions: assessment, goal setting, establishing interventions related to goals, monitoring success of the interventions, evaluating the success of the overall case plan and reporting outcomes.
Conducts regular discussion and updates with providers, primary care physicians, Medical Directors, pharmacists, and care management staff regarding the status of particular patients.
Serves as a member advocate to ensure the member receives all of the necessary care allowed under the members benefit plan.
Understands healthcare reimbursement methods that promote the provision of cost effective healthcare and the preservation of member benefits.
Utilizes community resource expertise and alternate funding arrangements available to plan members when services are not available under the benefits program.
Develops new programs as appropriate to reduce admissions for acute and chronic members and assist with decreasing inpatient lengths of stay, and preventing avoidable emergency room utilization.
Develops relationships with hospital social workers and community resources to assure appropriate care management of catastrophic, acute, and chronically ill members.
Assists in the identification and reporting of potential quality improvement issues. Responsible for assuring these issues are reported to the appropriate department.
Directs social work interventions including coordinating the distribution, collection, and evaluation of personal health questionnaires to eligible clients, performing psychosocial assessment of the populations, telephone follow-up and in-home or facility assessments as indicated, documentation of problems, assessments and/or interventions.
Complies with all state requirements in the state where job duties are performed.
Minimum of 2 years experience in medical social work or case management.
Ability to travel locally as required.
Experience with managed care preferred.
Strong knowledge of medical terminology preferred.
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Licensed Social Worker (LSW) is REQUIRED
LCSW is preferred
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Full-Time Telework (WAH)
Considered only for locations in a specific region, state, or city; training period in the office may be required
ADDITIONAL JOB INFORMATION
This position is a work at home position and allows for some autonomy. Wellness benefits available.
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