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Licensed (LSW) Special Needs Representative

Primary Location: Philadelphia, PA
Additional Locations: PA-Philadelphia
Candidates will need to reside in the state of Pennsylvania. There is a potential for office based training in Philadelphia for a few weeks before transitioning to work at home.

Responsible for the proactive identification of members with special needs based on referrals from within or outside of the health plan. Coordinates access to care and services that are appropriate to the member’s condition or circumstance.

Fundamental Components:
-Responsible for reviewing state and/or health plan reports that identify members classified with special needs.
-Initiates referrals to case management as appropriate.
-Assesses members access needs for primary, specialist, durable medical equipment, and community services.
-Provides assistance to members to obtain necessary services to avoid delay in treatment.
-Compiles, documents, and maintains all appropriate documentation.
-Assists members with the completion of all necessary applications.
-Secures required data and submits the necessary documentation to the appropriate government office.
-Provides follow-up on all pending applications as required. Interfaces with members via telephone, written communication, and/or home visits.
-Collects and analyzes program data.
-Prepares reports that identify and interpret trends to assist in identifying member’s needs.
-Serves as a liaison between members, providers, and staff.
-Consults with health plan Medical Director on special needs cases as necessary.
-May participate in state directed meetings and/or in-services on providing care and coordination of care for the special needs population. Performs other duties as required.

Background Experience:
-A minimum of a Master's degree is required
-An LSW is required
-Knowledge of community agencies is required
-Experience with Microsoft Office programs (Excel and Word) is required
-1+ years of experience working with special needs populations similar to those served by Medicare and/or Medicaid required
-Strong verbal and written communication skills
-Ability to perform duties with minimal supervision
-Must be detail-oriented

Additional Job Information:
Able to be on a phone queue daily troubleshooting special needs issues from Medicaid and CHIP members.

Required Skills:
Service - Handling Service Challenges

Desired Skills:
Benefits Management - Encouraging Wellness and Prevention

Functional Skills:
Medical Management - Medical Management - Direct patient care, Medical Management - Medical Management - Managed Care/Insurance Clinical Staff

Technology Experience:
Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Mental Health - Licensed Social Worker (LSW)

Potential Telework Position:

Percent of Travel Required:
0 - 10%

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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