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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: Orlando, Florida
Additional Locations: FL-Orlando
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Description:

This role is Work at Home, but the candidate must live and travel in Osceola County, FL!


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.



Fundamental Components:

-Conducts comprehensive evaluation of Members using care management tools and information/data review
-Coordinates and implements assigned care plan activities and monitors care plan progress
-Conducts 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 case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.








Background Experience:

-Managed Care experience (Preferred)
-Long Term Care experience (Preferred)
-Case management and discharge planning experience (Preferred)
-2 years experience in behavioral health, social services or appropriate related field equivalent to program focus (Required)
-Bi-lingual preferred (Spanish/ English)
-Candidate must have computer data entry knowledge, excel, word (Required)





Additional Job Information:
Case manager will be the primary CM responsible for ongoing care coordination and management of LTC/Comprehensive plan members. Case manager completes comprehensive psychosocial needs assessment, resource identification-including informal resources-resource allocation; care plan development, effective time management

Required Skills:
Benefits Management - Maximizing Healthcare Quality, General Business - Applying Reasoned Judgment, Leadership - Driving a Culture of Compliance, Service - Case Administration, Technology - Leveraging Technology

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. 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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