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TX STAR+PLUS Service Coordinator 2-Case Mgmt Coordinator

Primary Location: McAllen, TX
Additional Locations: TX-McAllen
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: Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy and Zapata. 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. This position requires routine travel in the Hidalgo service area, 80-90% of the time. Some travel to the McAllen area office, support location, may also be required. 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:
Evaluation of Members: -Through the use of care management tools and information/data review, conducts comprehensive telephonic and face to face 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 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:
  • 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus
  • Bilingual skills preferred (Spanish)
  • Managed Care experience preferred
  • 2+ years in care management experience preferred
  • Discharge planning experience preferred
  • Minimum of a Bachelor's degree OR a non-licensed master level clinician is required: with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling).
  • 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.

Additional Job Information:
  • HIDALGO SERVICE AREA: Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Start, Webb, Willacy and Zapata counties.
  • Use of personal vehicle when traveling in the field, must have active and valid TX driver's license, reliable transportation and vehicle insurance.
  • Working environment with productivity and quality expectations
  • Ability to multitask, prioritize, and effectively adapt to a fast changing environment
  • Effective communication skills, both verbal and written

Required Skills:
Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts, General Business - Demonstrating Business and Industry Acumen

Desired Skills:
General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results, Leadership - Fostering a Global Perspective

Functional Skills:
Clinical / Medical - Direct patient care (hospital, private practice), Medical Management - Medical Management - Case Management

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft SharePoint, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Potential Telework Position:

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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