Aetna Case Management Coordinator - MULTIPLE OPENINGS AVAILABLE! (VA MCD) in Chantilly, Virginia

Req ID: 43982BR

JOIN OUR GROWING TEAM

We currently have multiple Case Management Coordinator opportunities to join our growing Aetna Better Health of Virginia team in the greater Chantilly, VA area!

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

POSITION SUMMARY

The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. Please note that this position is anticipated in Chantilly, VA and surrounding geographic areas, and requires routine and frequent field-based travel.

Fundamental Components of the Case Management Coordinator role include, but are not limited to:

Evaluation of Members:

Through the use of care management 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 members 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 case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

BACKGROUND/EXPERIENCE desired:

Managed Care experience preferred. Case management and discharge planning experience preferred. Minimum of 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus required. Computer literacy and demonstrated proficiency with MS Office Suite and strong keyboard navigation skills are required.

EDUCATION

The minimum level of education desired for candidates in this position is a Bachelor's degree in a relevant field or equivalent experience.

FUNCTIONAL EXPERIENCES

Functional - Medical Management/Medical Management - Case Management/1-3 Years

Functional - Medical Management/Medical Management - Managed Care/Insurance Administration/1-3 Years

Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years

Functional - Medical Management/Medical Management - Discharge planning/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Word/4-6 Years/End User

Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User

Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User

Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Understanding Clinical Impacts/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

Benefits Management/Interacting with Medical Professionals/ADVANCED

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Leadership/Fostering a Global Perspective/FOUNDATION

General Business/Communicating for Impact/FOUNDATION

Telework Specifications:

Work-at-Home (WAH) is anticipated, timeline for transition to work at home post training completion and demonstrated performance. Positions will require frequent and routine field based travel.

ADDITIONAL JOB INFORMATION

Case management and discharge planning experience preferred 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus Managed Care experience highly desired Education and Licensure Requirements- -Minimum of a Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or relevant/related human services preferred (psychology, social work, marriage and family therapy, counseling). Ability to travel with personal vehicle to member locations. Must have dependable transportation, proof of insurance and valid VA drivers license.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

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.

Job Function: Health Care