Aetna Insurance Jobs – Clinical Case Manager BH

Job Description:

Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Job Responsibilities:

• 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
• Ability to speak to medical and behavioral health professionals to influence appropriate member care.
• Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health
• In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals
• Identifies and escalates quality of care issues through established channels
• Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
• Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Job Requirements:

• 3 years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
• Behavioral health or waiver experience preferred
• Foster care experience preferred
• Crisis intervention skills preferred
• Managed care/utilization review experience preferred
• Case management and discharge planning experience preferred
• Minimum of a Master’s degree in Behavioral/Mental Health or related field
• License in Social Work with Masters Required (e.g. LCSW, LMSW, LICSW,etc)

Job Details:

Company: Aetna

Vacancy Type:  Full Time

Job Location: Charleston, WV, US

Application Deadline: N/A

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