Aetna Job Openings – Case Management Coordinator

Job Description:

The Intensive Case Management Coordinator is a field-based position. This position utilizes critical thinking and professional judgment to collaborate and support the case management process, in order to facilitate improved healthcare outcomes for members with intensive physical and/or behavioral care needs by providing advocacy, coordination, collaboration, support and education through the use of care management tools and resources.

Job Responsibilities:

• Provides modifications to care plan to reflect changing needs.
• Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Helps member actively and knowledgeably participate with their provider in healthcare decision-making.
• Integrates all biopsychosocial information and recommends a holistic approach to supporting the member comprehensive care needs by evaluating and coordinating internal and external programs/services that are available within the member’s benefit plan.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Identifies and proactively addresses high risk factors and service needs that may impact member outcomes through care planning interventions.
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Through the use of care management tools and information/data review, conducts comprehensive assessments of member’s needs/eligibility.
• Identifies and escalates quality of care issues through established channels.
• Provide crisis support and stabilization as needed.

Job Requirements:

• A non-licensed Master level clinician with either degree being in Behavioral Health or a Human Services field of study preferred.
• Managed care experience preferred.
• 1+ year(s) experience and detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the Kentucky SKY populations, is required.
• 1+ year(s) experience in computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel required.
• Bachelor’s degree with either degree being in Behavioral Health or a Human Services field of study required.
• Case management and/or discharge planning experience preferred.
• 1+ year(s) experience in and knowledge of Behavior Health Services and knowledge of best practice treatment delivery systems for intensive member care needs or social services required.

Job Details:

Company: Aetna

Vacancy Type:  Full Time

Job Location: Cincinnati, OH, US

Application Deadline: N/A

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