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Social Worker

Primary Location: Dallas, Texas
Additional Locations: TX-Dallas
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Description:

Candidates must be located in Dallas, TX due to local travel involved.

Aetna Community Care is a member centric, team-delivered,
community based care management model that joins members where they are.




The Social Worker, works within an Interdisciplinary Care Team setting, and is
responsible in supporting member-centered care management across the health
care continuum, to ensure services are being provided to, members and their
families. Provides assessments that address social and behavioral health
outcome indicators. Addresses social determinants of health and actively
participates in the members plan of care, to promote effective utilization of
plan benefits, available resources, supports optimal member functioning, while
assuring cost-effective outcomes.


The Social Worker will also function as a coordinator of care for
members in our Joint Venture programs that are identified as having long term
rehabilitation and/or psychosocial needs as a result of birth defects, chronic
conditions, illness or injury for members to prevent exacerbations,
readmissions or need for placement into custodial care. This position may
specialize within a disease area and may serve in a consultative role to other
health care professionals.



Fundamental Components:

Assessment of members through use of clinical tools/review of member-specific health information/data. Utilizes
professional judgment in completing Assessments in the Med-Compass System

- Conducts comprehensive assessments of referred members needs/eligibility; in
collaboration with the members Interdisciplinary Care Team (ICT) determines an
approach to resolve member issues/meeting needs by evaluating the members
benefit plan & available internal/external programs/services/resources

- Applies clinical judgment to incorporate strategies designed to reduce risk
factors & barriers; address clinical indicators & barriers which impact
care planning/resolution of member issues

- Using advanced clinical skills, prioritizes members experiencing acute
behavioral health/medical issues & refers to the appropriate
clinical/service providers for thorough assessment & treatment

- Conducts in person and telephonic assessments & consultations with
members/families

- Provides crisis follow up to members and their families to ensure they are
receiving the appropriate treatment and services. Involves other members of the
Interdisciplinary Care Team (ICT) and documents follow up in Med Compass system

- Makes timely contact with the Member; provides services in accordance with
the approved Social Work policy

- Using a holistic approach consults with clinical colleagues, supervisors,
Medical Directors, other members of the (ICT) & other programs to overcome
barriers to meeting goals/objectives. Presents cases at case rounds/conferences
to obtain a multidisciplinary perspective and recommendations as requested and
appropriate

- Identifies/escalates member safety & quality of care issues through
established channels that are in accordance with the Procedure, Conduct and
Safety for Face to Face Visits

- Collaborates w/medical & behavioral health professionals to coordinate
member care

- Utilizes influencing/motivational interviewing skills to ensure maximum
member engagement; promotes lifestyle/behavior -changes to achieve optimum
level of health

- Provides coaching, information & support to empower the member to make
ongoing independent medical/healthy lifestyle choices

- Helps member actively & knowledgeably participate w/their provider in
healthcare decision-making

- Utilizes negotiation skills to secure appropriate options & services
necessary to meet the members benefits/healthcare needs

- In collaboration with the member & ICT, develops & monitors
established plans of care to meet the member goals
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-Serves as
a member advocate to ensure the member receives all of the necessary care allowed under the member’s benefit plan.

-Conducts
regular discussion and updates with providers, primary care physicians, Medical Directors, pharmacists, and care management staff regarding the status of patients



Background Experience:

LCSW required

3+ years clinical experience required

Ability to travel locally required


Case management experience preferred

Crisis intervention experience preferred

Behavioral health experience preferred

Discharge planning experience preferred



Education:
Mental Health - Licensed Clinical Social Worker

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.

Click To Review Our Benefits (PDF)

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