Case Management CoordinatorPrimary Location: Phoenix, Arizona
Additional Locations: AZ-Phoenix Apply
Required hours are Monday-Friday 8am-5pm.
Utilizes critical thinking and knowledge of program requirements, network and community resources, and Medicaid benefits to facilitate appropriate physical and behavioral healthcare for members through collaboration with external and internal partners.
62101Fundamental Components: -Using processes and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility for transfer to plan.
-Consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases to multidisciplinary team to ensure
-Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
-Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
-Identifies and escalates quality of care issues through established channels.
-Assesses any issues with court ordered treatment that may affect transfer to the plan.
Background Experience: -Prior Medicaid and/or AHCCCS experience required
-Court/Justice experience preferred
-Experience in behavioral health or social services is preferred
-Managed Care experience preferred
-Case management and discharge planning experience preferred
-Strong attention to detail and time management skills are required
Additional Job Information: Role is responsible for the transition of members between RBHA. This includes the review of clinical records, and working closely with internal and external providers. Must be detail oriented and organized. Required Skills: Benefits Management - Interacting with Medical Professionals, Service - Handling Service Challenges, Service - Working Across Boundaries Desired Skills: Benefits Management - Understanding Clinical Impacts, General Business - Communicating for Impact Functional Skills: Administration / Operation - Data Entry, Administration / Operation - File Maintenance, Customer Service - Customer Service - Plan Sponsor - Benefit provision review Technology Experience: Database - Intuit QuickBase, Desktop Tool - Microsoft Outlook, 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
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