Case Management CoordinatorPrimary Location: Norfolk, VA
Additional Locations: VA-Norfolk Apply
Standard business hours Monday-Friday.
65804Fundamental 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 knowledgably 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.
- 10-25% field-based travel with personal vehicle is required in the assigned service area. Background Experience: Qualification Requirements:
- 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.
- Ability to support the complexity of members needs including face-to-face visitation required
- Ability to travel in the field (~10-25%), 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
- 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
Additional Job Information: Case management and discharge planning experience preferred 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus Managed Care experience highly desired Education and Licensure Requirements- -Minimum of a Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or relevant/related human services preferred (psychology, social work, marriage and family therapy, counseling). Ability to travel with personal vehicle to member locations. Must have dependable transportation, proof of insurance and valid VA drivers license. 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 - Discharge planning, Medical Management - Medical Management - Managed Care/Insurance Administration Technology Experience: Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook 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.
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