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A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Case Management Coordinator

Primary Location: Norfolk, Virginia
Additional Locations: VA-Norfolk
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Description:
The Care Management Coordinator services Aetna Better Health of Virginia
members; utilizes critical thinking and judgment to collaborate and inform the
service coordination process, in order to facilitate appropriate healthcare
outcomes for members by providing care coordination, support and education for
members through the use of service coordination tools and resources.


Territory Tidewater region.


Schedule Monday-Friday business hours


Fundamental Components:

- Through the use of service coordination tools and information/data review, conduct
comprehensive evaluation of referred members needs/eligibility and recommend an
approach to case resolution and/or meeting needs by evaluating members 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.

- Monitoring, evaluation and documentation of care: utilizes service
coordination and quality management processes in compliance with regulatory and
accreditation guidelines and company policies and procedures.

- 25-50% field-based travel with personal vehicle is required in the
assigned service area.


Background Experience:
EDUCATION
- A Bachelor's degree in Social Work (BSW); a Bachelor's degree with
a relevant major (Psychology, Human Services, Healthcare Administration,
Sociology) and related professional background; or a Master
level clinician with Social Work degree (MSW) required.


QUALIFICATIONS NEEDED
- Ability to support the complexity of members needs including face-to-face
visitation required

- Ability to travel in the field (25-50%), personal vehicle, valid drivers
license, and proof of insurance is required.

- Computer proficiency with Microsoft Excel, Word, including navigating
multiple systems and keyboarding required

- Ability to multitask, prioritize, and effectively adapt to a fast paced
changing environment required


Additional Job Information:
- 2 years experience in behavioral health, social services preferred

- Previous service coordination or case management experience preferred

- Long term (LT) services and support experience preferred

- Waiver experience preferred

- LT support for children and special needs children populations preferred

- Managed Care experience preferred

- Discharge planning experience preferred

- Experience and knowledge required in clinical guidelines, systems and tools
i.e., Milliman, Interqual

- Bilingual in English and Spanish preferred

- Knowledge of community resources and provider networks preferred

- Familiarity with local health care delivery systems preferred


Required Skills:
Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts

Desired Skills:
Technology - Leveraging Technology

Functional Skills:
Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff

Technology Experience:
Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook

Education:
Mental Health - Licensed Clinical Social Worker

Potential Telework Position:
Yes

Percent of Travel Required:
25 - 50%

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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