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Texas Health Aetna Social Worker Clinical Navigator

Primary Location: Arlington, TX
Additional Locations: TX-Arlington
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Description:
With a focus on delivering comprehensive, patient-centered care across the health care continuum, the Navigator position is a critical role that implements, supports and promotes Texas Health | Aetna’s Care Management strategies, specifically the THA Navigation Center. This telephonic position provides patient-centered support and guidance to individuals covered by Texas Health Aetna with a focus on those with medium/high risk for morbidity, mortality and poor outcomes (also known as members with “rising risk”).
Utilizing clinical judgment and critical thinking skills, the Social Worker Navigator assesses, identifies, and facilitates appropriate physical and behavioral healthcare and social services for members through assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services.
With these skills and through effective partnerships with the member themselves, their caregivers/families, community and other resources, other members of the Navigation Center (LPN Navigator and Care Management Associate) and the member’s physician, the Social Work Navigator promotes effective in-network utilization of available resources, optimal member functioning and empowerment, promotion of Primary Care Physician (PCP), and cost-effective outcomes.

Fundamental Components:
Supports Texas Health | Aetna’s mission and values while promoting a positive culture. Assessment of Members using clinical tools and reviewing of member-specific health information/data. Conducts an evaluation of member’s needs and benefit plan eligibility for available internal and external programs/services and resources and facilitates integration.Uses knowledge and experience of lifestyle risk behaviors to conduct an evaluation of member’s health status and lifestyle risk. Utilizes assessment techniques to determine member’s health status and needs. Utilizes skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Helps member actively and knowledgeably participate with their provider in healthcare decision-making. Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs. Facilitates member access to appropriate medical and specialty providers as well as other care coordination team support specialists (e.g. LPN, JV Care Management Team (JV CMT) for high risk members, etc.). . Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs. Uses judgement to determine when a case is triaged to the JV CMT for prompt comprehensive oversight. Consults with the Director of JV Care Management, Chief Medical Officer and/or others to assist member with meeting health needs. Identifies and escalates quality of care issues through established channels. Ability to speak to medical and behavioral health professionals to influence appropriate member care. Identifies and escalates quality of care issues under the Director of JV Care Management


Background Experience:
.

Additional Job Information:
Licensed Social Worker (LSW) with current and unrestricted license
  • 3-5 years practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required
  • Behavioral Health experience preferred
  • Case management and discharge planning experience preferred
  • Managed Care experience preferred
  • Crisis intervention skills preferred
  • Bilingual (English/Spanish) preferred


Education:
Mental Health - Licensed Social Worker (LSW)

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
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.

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