Uncategorized – Charlotteville – DOE
Aetna is looking to fill the position titled Care Management Coordinator.
POSITION SUMMARY
Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Virginia is looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Virginia Medicaid Long Term Services and Supports members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Virginia, and we will support you all the way.
The Care Management Coordinator services Aetna Better Health of Virginia members; utilizes critical thinking and judgment to collaborate and inform the service coordination process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of service coordination tools and resources.
Fundamental components include, but are not limited to:
– Through the use of service coordination tools and information/data review, conducts comprehensive evaluation of referred members needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members 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 referral to clinical case management or crisis intervention as appropriate.
– Coordinates and implements assigned care plan activities and monitors care plan progress.
– Enhancement of medical appropriateness and quality of care.
– Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting 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 knowledgably participate with their provider in healthcare decision-making.
– Monitoring, evaluation and documentation of care: utilizes service coordination and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
– 10-25% field-based travel with personal vehicle is required in the assigned service area.
Qualification Requirements:
– A Bachelor’s degree in Social Work (BSW); a Bachelor’s degree with a relevant major (Psychology, Human Services, Healthcare Administration, Sociology) and related professional background; or a Master level clinician with Social Work degree (MSW) required
– Ability to support the complexity of members needs including face-to-face visitation required
– Ability to travel in the field (~10-25%), personal vehicle, valid drivers license, and proof of insurance is required.
– Computer proficiency with Microsoft Excel, Word, including navigating multiple systems and keyboarding required
– Ability to multitask, prioritize, and effectively adapt to a fast paced changing environment required
Preferred Skills:
– 2 years experience in behavioral health, social services preferred
– Previous service coordination or case management experience preferred
– Long term (LT) services and support experience preferred
– Waiver experience preferred
– LT support for children and special needs children populations preferred
– Managed Care experience preferred
– Discharge planning experience preferred
– Experience and knowledge required in clinical guidelines, systems and tools i.e., Milliman, Interqual
– Bilingual in English and Spanish preferred
– Knowledge of community resources and provider networks preferred
– Familiarity with local health care delivery systems preferred
Education:
The minimum level of education desired for candidates in this position is a Bachelor’s degree or equivalent experience.
Please send your resume to OktavianiK@aetna.com
Contact Karina Oktaviani if interested.
1560 Broadway Suite 500, Denver, Colorado, 80202
OktavianiK@aetna.com