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Social Worker

Primary Location: San Antonio, TX
Additional Locations: TX-San Antonio
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Description:
This is an in-office position in the San Antonio, TX office.

Functions as a coordinator of care for members identified as having long-term rehabilitation and/or psychosocial needs as a result of birth defects, chronic conditions, illness or injury for members to prevent exacerbations, re-admissions or need for placement into custodial care. Responsible for implementing and coordinating all case management, psychosocial, and quality of life activities relating to cases across the continuum of care including consultant referrals, home care visits, use of community resources and alternative levels of care. Responsible for developing and carrying out strategies to coordinate and integrate all acute and long-term care services to the members, and to those in case and disease management. Provides psychosocial interventions through resource identification, program development and other means. This position may specialize within a disease area and may serve in a consultative role to other health care professionals.

Fundamental Components:
Responsible for the comprehensive management of members with acute or chronic conditions. Case management activities will focus on quality of care, compliance, outcomes and decreasing costs. Responsible for developing and carrying out strategies to coordinate and integrate all acute and long-term care services to members to prevent exacerbations and/or placement of the members in custodial care. Performs initial and periodic assessments of the members enrolled in the Long-Term Care Program and/or case or disease management programs. Applies case management concepts, principles and strategies in the development of an individualized case plan for enrolled members in case or disease management that are at risk of poor outcomes. The case plan addresses the member’s broad spectrum of needs. The case planning process includes the following actions: assessment, goal setting, establishing interventions related to goals, monitoring success of the interventions, evaluating the success of the overall case plan and reporting outcomes. Conducts regular discussion and updates with providers, primary care physicians, Medical Directors, pharmacists, and care management staff regarding the status of particular patients. Serves as a member advocate to ensure the member receives all of the necessary care allowed under the member’s benefit plan. Understands healthcare reimbursement methods that promote the provision of cost effective healthcare and the preservation of member benefits.

Utilizes community resource expertise and alternate funding arrangements available to plan members when services are not available under the benefits program. Develops new programs as appropriate to reduce admissions for acute and chronic members and assist with decreasing inpatient lengths of stay, and preventing avoidable emergency room utilization. Develops relationships with hospital social workers and community resources to assure appropriate care management of catastrophic, acute, and chronically ill members. Assists in the identification and reporting of potential quality improvement issues. Responsible for assuring these issues are reported to the appropriate department. Directs social work interventions including coordinating the distribution, collection, and evaluation of personal health questionnaires to eligible clients, performing psychosocial assessment of the populations, telephone follow-up and in-home or facility assessments as indicated, documentation of problems, assessments, and/or interventions, and promoting ease of access to a continuum of care through appropriate information and referral. For employees providing disease management for Medicaid members, this role is also responsible for implementing and coordinating case management activities related to the use of community resources and behavioral health issues. Provides psychosocial interventions through resource identification, program development, and other means. May serve in a consultative role to other health care professionals. Assists with securing community resources and facilitates transportation as appropriate. Performs other duties as required.

Background Experience:
3+ years of direct clinical practice experience required, e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility preferred
Social work licensure required (LSW, LMSW , LCSW)
Strong computer skills required
Case management and discharge planning experience preferred
Managed care/utilization review experience preferred.



Additional Job Information:
Knowledge of the regulations, standards, and policies which relate to social work practice.Knowledge of individual and group behavior and inter-relationships among social, economic psychological and physical factors.Extensive knowledge of community resources.Thorough knowledge of casework and group work principles, practices, and methodology.

Required Skills:
Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts, General Business - Applying Reasoned Judgment

Desired Skills:
Finance - Managing Aetnas Risk, General Business - Turning Data into Information, Leadership - Collaborating for Results

Functional Skills:
Medical Management - Medical Management - Case Management, Medical Management - Medical Management - Discharge planning

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

Education:
Mental Health - Licensed Social Worker

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.

Click To Review Our Benefits (PDF)

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