Aetna Social Worker in Albany, New York

Req ID: 53641BR

Licensed Social Worker (LSW) - REQUIRED

Must be located in IL, IN, NY, or MO.

POSITION SUMMARY

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.

Fundamental Components:

  • 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.

BACKGROUND/EXPERIENCE desired:

  • 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.

EDUCATION

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

FUNCTIONAL EXPERIENCES

Functional - Medical Management/Medical Management - Case Management/1-3 Years

Functional - Customer Service//1-3 Years

Functional - Clinical / Medical//1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

Telework Specifications:

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.

Aetna takes our candidates'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