Aetna Social Worker (San Antonio) in San Antonio, Texas
Req ID: 49082BR
We are building an exciting new clinical and member experience program at Aetna. Aetna Community Care is a member centric, team-delivered, community based care management model that joins members where they are.
The Social Worker, works within an Interdisciplinary Care Team setting, and is responsible in supporting member-centered care management across the health care continuum, to ensure services are being provided to, members and their families. Provides assessments that address social and behavioral health outcome indicators. Addresses social determinants of health and actively participates in the members plan of care, to promote effective utilization of plan benefits, available resources, supports optimal member functioning, while assuring cost-effective outcomes.
Assessment of members through use of clinical tools/review of member-specific health information/data.
Utilizes professional judgment in completing Assessments in the Med-Compass System
Conducts comprehensive assessments of referred members needs/eligibility; in collaboration with the members Interdisciplinary Care Team (ICT) determines an approach to resolve member issues/meeting needs by evaluating the members benefit plan & available internal/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 in person assessments & consultations with members/families
Provides crisis follow up to members and their families to ensure they are receiving the appropriate treatment and services.
Involves other members of the Interdisciplinary Care Team (ICT) and documents follow up in Med Compass system
Makes timely contact with the Member;provides services in accordance with the approved Social Work policy
Using a holistic approach consults with clinical colleagues, supervisors, Medical Directors, other members of the (ICT) & other programs to overcome barriers to meeting goals/objectives.
Presents cases at case rounds/conferences to obtain a multidisciplinary perspective and recommendations as requested and appropriate Identifies/escalates member safety & quality of care issues through established channels that are in accordance with the Procedure, Conduct and Safety for Face to Face Visits
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 & 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 & ICT, develops & monitors established plans of care to meet the member goals.
The minimum level of education required for candidates in this position is a Master's degree
Licenses/ Certifications: Licensed Clinical Social Worker (LCSW); active and in good standing.
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
Social workers are required to use their own vehicle and will be reimbursed mileage.
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
The highest level of education desired for candidates in this position is a Master's degree.
Licenses and Certifications:
Licensed Clinical Social Worker (LCSW), active and in good standing
Zone 7 - San Antonio
Travel is required within the assigned zone. The amount of daily mileage and travel time will vary.
ADDITIONAL JOB INFORMATION
Consults w/ICT/other appropriate programs/resources to overcome barriers to meeting goals, interventions; 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
Documents all communications through Case Logs, Case Notes and Care Plan ,with Members in the Med Compass System and adheres to documentation policies of within 24 hours of member contact Provides data, and other case information as requested by the Program Manager and other Senior Members of the Leadership Team.
Responds to Program Manager and other members on the Senior Leadership team upon request
Utilizes SharePoint to access all training and program guidances for Aetna Community Care
Actively utilizes ACC Policies and Procedures and implements best practices by following documented procedures through ACC SharePoint.
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.
Job Function: Health Care