Clinical Case Manager BHPrimary Location: Overland Park, KS
Additional Locations: KS-Overland Park Apply
Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of biopsychosocial services, supports and resources to promote effective utilization of available resources and optimal, cost-effective outcomes.
65950Fundamental Components: Assessment of Members:
- Through the use of clinical tools and data, The CCM conducts comprehensive member assessments related to members' needs and waiver eligibility.
- The assessment findings assist with guiding the approach used to work with the member to develop a service plan that meets their stated goals and objectives.
- The CCM utilizes appropriate internal and external programs/services to develop the healthcare support network with member.
- The CCM incorporates clinical strategies designed to reduce risk factors and address complex clinical indicators which serve as barriers to resolution of member issues.
- Using advanced clinical skills, the CCM provides crisis intervention services with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment.
- The CCM also follows up with members and providers to ensure they are receiving the appropriate treatment/services.
- Using a holistic approach, the CCM consults with supervisors, Medical Directors and/or other departments/community providers to overcome barriers.
- The CCM presents at case conferences and participates in Rounds in order to obtain multidisciplinary view for optimal outcomes.
- CCM is familiar with quality of care issues and is able to escalate concerns through established channels.
- The CCM demonstrates the ability to speak to medical and behavioral health professionals to influence appropriate member care.
- Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes 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
- Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
- In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Master's degree in Behavioral/Mental Health or related field and unencumbered Behavioral Health clinical license in KS is required (LMSCW, LSCSW, LMLP, LPC)
3 or more years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care (FQHC) or outpatient clinic/facility, Community Mental Health Center Clinical Case Manager, Home Health, Hospice, or other community based integrated care setting.
Experience working within hospice, home health and/or substance abuse
Crisis intervention skills, trauma informed care and motivational interviewing skills strongly preferred.
Managed care service coordination, discharge planning and/or transitional care coordination experience preferred. Additional Job Information: Organization
Enjoys fast pace and shifting priorities
Adaptive, Flexible, Responsive
Motivated by challenging issues that require problem solving Required Skills: Service - Handling Service Challenges, Service - Providing Solutions to Constituent Needs, Technology - Leveraging Technology Desired Skills: Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Maximizing Healthcare Quality, General Business - Maximizing Work Practices Functional Skills: Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Direct patient care, Medical Management - Medical Management - Discharge planning, Medical Management - Medical Management - Home health care Technology Experience: Aetna Application - Aetna Behavioral Health, Aetna Application - Aetna Internet site at www.aetna.com, Aetna Application - Aetna Learning Center (formerly LMS), Aetna Application - AetNet Intranet Site: aetnet.aetna.com/ Education: Mental Health - Licensed Clinical Social Worker, Mental Health - Licensed Master Social Worker (LMSW), Mental Health - Licensed Professional Counselor 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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