Case Management CoordinatorPrimary Location: Orlando, FL
Additional Locations: FL-Longwood, FL-Orlando Apply
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.
Standard business hours Monday-Friday.
No nights, no weekends and no holidays.
Travel is local only and no over nights. Mileage reimbursed.
- 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.
2 years experience in behavioral health, social services or appropriate related field equivalent to program focus
Managed Care experience preferred
LTC (long term care) Experience and Spanish bi-lingual Candidate preferred.
Must have strong use of Microsoft office and ability to multitask
Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling).
701B Certification required.
Person Centered Care Planning Certification Preferred.
Preferred Candidate's residence- Central Florida Area. (NORTH WEST ORLANDO AREA IS REQUIRED: ZIP CODES
32810, 32808, 32818 AREAS)
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, care plan development, resource identification(formal and informal resources) resources for cost effective care planning; effective time management Required Skills: Benefits Management - Interacting with Medical Professionals, General Business - Applying Reasoned Judgment, Service - Case Administration Functional Skills: Administration / Operation - Data Entry, Medical Management - Medical Management - Case Management Technology Experience: Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel 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. 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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