Case Management CoordinatorPrimary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix Apply
Standard business hours of Monday-Friday 8-5pm will be required.
Mercy Care RBHA case manager utilizes critical thinking and 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 case manager supports integrated care to the members we serve. This is a community based position working in a contracted providers office 75% of work week with 25% of week work at home/office.
61682Fundamental 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: -1+ year of case management and discharge planning experience required
-2+ years experience in one of the following is required: behavioral health, medical health, or social services
-Managed care experience preferred.
-A minimum of a 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). Desired Skills: Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, General Business - Communicating for Impact 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 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.
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