Clinical Case Manager BHPrimary Location: Fort Worth, TX
Additional Locations: TX-Fort Worth Apply
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.
66811Fundamental 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
-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 in TX is required
3+ years clinical experience required
Master's degree required
Ability to travel within a designated geographic area required
Case management, behavioral health, discharge planning experience preferred
Managed care, Medicare or Medicaid experience preferred
Crisis intervention experience preferred
Bilingual in English and Spanish is preferred
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications
Education: Mental Health - Licensed Social Worker Potential Telework Position: Yes Percent of Travel Required: 50 - 75% 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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