Description: The Care Management Coordinator utilizes critical thinking and judgment to collaborate and inform the service coordination process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of service coordination tools and resources.
Routine field-based travel with personal vehicle is required in the assigned service area.
Fundamental Components: Evaluation of Members: - Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. - Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. - Coordinates and implements assigned care plan activities and monitors care plan progress.
Enhancement of Medical Appropriateness and Quality of Care: - 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. - Identifies and escalates quality of care issues through established channels. - Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs. - Utilizes influencing/ motivational interviewing 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.
Monitoring, Evaluation and Documentation of Care: - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Background Experience: - Bachelor's degree or non-licensed master level clinician required, with either degree being in Behavioral Health or Human Services preferred (ie. Psychology, Social Work, Marriage and Family Therapy, Counseling). - 2+ years experience in Behavioral Health, Social Services or appropriate related field equivalent to program focus required. - Familiarity with medical terminology strongly preferred. - Case management and discharge planning experience preferred, - Managed Care experience preferred. Additional Job Information: Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of West Virginia is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of our members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of West Virginia, and we will support you all the way. Required Skills: Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts Desired Skills: Benefits Management - Interacting with Medical Professionals, General Business - Communicating for Impact, General Business - Consulting for Solutions Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel Potential Telework Position: Yes Percent of Travel Required: 10 - 25% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this 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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