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Service Coordinator 2 - Texas Star Kids

Primary Location: Dallas, TX
Additional Locations: TX-Dallas
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Description:
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are 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 Texas STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.


This position will be working from home but will require routine travel in the Dallas service area, 80-90% of the time. Some travel to the Dallas office, support location, may also be required.

The Service Coordinator 2, (Case Management Coordinator) is a field based position that conducts comprehensive telephonic and face to face evaluations. Candidates may reside in any of these or adjacent counties: Collin, Dallas, Ellis, Hurt, Kaufman, Navarro, and Rockwall. Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. Use of personal vehicle when traveling in the field; must have active and valid TX driver's license, reliable transportation and vehicle insurance. Business mileage is eligible for reimbursement, in accordance with travel policy guidelines.


Fundamental Components:
Assessment of Members: Through the use of clinical tools and information/data review, conducts comprehensive face to face assessments of referred member’s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member’s benefit plans and available internal and external programs/services. - Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues. - Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services. Actively engage with providers and members during key transitions of care.

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. Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs. Reviews prior claims to address potential impact on current base management and eligibility. Assessment includes the member's level of work capacity and related restrictions/limitations. 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:
  • Minimum of 1 year previous service coordination or case management experience and experience with pediatric clients is required; integrated model experience is preferred
  • 2+ years experience in behavioral health, social services or appropriate related field equivalent to program focus preferred
  • Bilingual skills preferred (Spanish)
  • Managed Care experience preferred
  • Graduate degree in social work or related human services field (i.e., psychology, counseling, marriage and family therapy, etc.), a non-licensed master level clinician is required.
  • 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. Strong keyboard and mouse skills required
To view all open Texas Star Kids positions please visit: Texas Star Kids


Clinical Licensure:
N/A

Potential Telework Position:
Yes

Percent of Travel Required:
75 - 100%

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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