Telephonic Care Manager - Social WorkerPrimary Location: Harrisburg, Pennsylvania
Additional Locations: PA-Harrisburg Apply
We are building an exciting new clinical and member experience program at Aetna. 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. 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.
- 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 assessments & consultations with members/families, when appropriate however the primary responsibility is telephonic support of members as part of an office based telephonic team
- 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.
Background/ Experience Desired:
- 3+ years clinical practice experience, e.g., community, public health, hospital setting, alternative care setting such as -home health or ambulatory care required
- Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
- Case management, behavioral health, discharge planning experience preferred
- Managed Care, Medicare/Medicaid experience preferred
- Crisis intervention skills preferred
- Bilingual (Spanish, Creole and/or Vietnamese) preferred.
The highest level of education desired for candidates in this position is a Master's degree.
Mental Health/Licensed Clinical Social Worker (LCSW) in state of PA or NJ; active and in good standing.
Additional Job Information:
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
Aetna takes our candidates'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.
58890Potential Telework Position: No Percent of Travel Required: 0 - 10%
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