Case Management CoordinatorPrimary Location: Detroit, MI
Additional Locations: MI-Detroit Apply
75-100% of travel is required around Wayne and Macomb County.
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.
63883Fundamental 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 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 knowledgably 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: -A minimum of an LBSW is required
-2+ years experience in behavioral health or social services required
-Managed Care experience preferred
-Case management and discharge planning experience preferred Additional Job Information: Experience in making face to face home visits with members / enrollees Required Skills: General Business - Communicating for Impact, Leadership - Collaborating for Results, Service - Case Administration Desired Skills: Benefits Management - Understanding Clinical Impacts, Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance Functional Skills: Clinical / Medical - Disease management, Clinical / Medical - General Management, Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff Technology Experience: Desktop Tool - Microsoft Exchange, Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint Education: Mental Health - Licensed Social Worker (LSW) 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. 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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