Care Management CoordinatorPrimary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix Apply
Mercy Care RBHA care manager 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.
Mercy Care RBHA care manager utilizes knowledge of program requirements, network and community resources to facilitate appropriate physical and behavioral healthcare and social services for members through collaboration with internal and external providers. Mercy Care RBHA care manager supports integrated care for the members, which centers on targeting social determinants of health concerns.
62889Fundamental Components: Evaluation of Members;
-Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s 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 referrals.
-Coordinates and implements assigned care plan activities and monitors care plan progress.
Enhancement of Medical Appropriateness and Quality of Care;
-Uses a holistic approach to overcome barriers to meet 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 knowledgeably participate with their provider in healthcare decision-making.
Monitoring, Evaluation, and Documentation of Care;
- Utilizes case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.Background Experience: -2+ years of experience in behavioral health or social services required
-A minimum of a Bachelor's degree or non-licensed master level clinician required
-Case management and discharge planning experience preferred
-Managed Care experience preferred
Additional Job Information: This role requires sitting onsite at a clinic 3 days per week and the remaining 2 days a week can be work at home or in office.
Standard business hours of Monday-Friday 8-5pm will be required.
Desired Skills: Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality Functional Skills: Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Discharge planning, Medical Management - Medical Management - Disease management Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - Microsoft Word Potential Telework Position: Yes Percent of Travel Required: 0 - 10% 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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