Description: 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.
Schedule is Monday-Friday standard business hours.
Travel is 50-75% locally to Hillsborough County and serving 5 counties: Manatee, Polk, Hardee, and Highlands.
64144 Fundamental Components:
- Conducts comprehensive evaluation of Members using care
management tools and information/data review
- Coordinates and implements assigned care plan activities
and monitors care plan progress
- Identifies and escalates quality of care issues through
- 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 participate with
their provider in healthcare decision-making
Monitoring, Evaluation and Documentation of Care: Utilizes Background Experience:
case management and quality management processes in compliance with regulatory
and accreditation guidelines and company policies and procedures.
- Managed Care experience preferred
- Bi-lingual Spanish required
- 2 years experience in case management, behavioral health, social services or appropriate related field equivalent to program focus
- Long Term Care LTC preferred
- Candidate must reside in Hillsborough County, FL.
Additional Job Information:
- Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services (psychology, social work, marriage and family therapy, counseling).
This role requires visits to be completed with our members at their private homes, Assisted Living Facilities, Adult Family Care Homes and Nursing Homes. When the candidate is not completing visits they will be working from their home office completing documentation, case notes and coordinating services.
- Must be willing & able to travel within the service area
- Must have unrestricted driver's license, active insurance and reliable transportation
- Must be self-motivated and able to work independently
- Must be able to multitask and be priority driven
- Must be detail oriented
- Must be able to effectively and efficiently navigate various computer systems and programs
- Must be able to meet documentation standards
Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, Service - Case Administration, Service - Providing Solutions to Constituent Needs, Service - Working Across Boundaries Desired Skills:
Benefits Management - Understanding Clinical Impacts, Service - Handling Service Challenges Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel Potential Telework Position:
Yes Percent of Travel Required:
50 - 75% 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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