Aetna Clinical Care Manager in Chicago, Illinois

Req ID: 38000BR

Looking for candidates who reside in Chicago and suburban cook county, specifically south and west.

Technical experience - Preferred candidates will have 1-3 years experience with Microsoft Word, Excel and Outlook

POSITION SUMMARY

The MLTSS Clinical Care Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Fundamental Components:

Enhancement of Medical Appropriateness and Quality of Care:- Application and/or interpretation of applicable criteria

and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while

assessing benefits and/or members needs to ensure appropriate administration of benefits

  • Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to

    meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve

    optimal outcomes

  • Identifies and escalates quality of care issues through established channels

    -Ability to speak to medical and behavioral health professionals to influence appropriate member care.

  • Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes 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 1

    -Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify

    comprehensive member needs.

    Assessment of Members:

    Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred

    members needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating members

    benefit plan and available internal and external programs/services.- Applies clinical judgment to the incorporation of

    strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and

    resolution of member issues.

  • Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical

    crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically

    indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services. Monitoring, Evaluation and Documentation of Care:-In collaboration with the member and their care team develops

    and monitors established plans of care to meet the members goals

    -Utilizes case management and quality management processes in compliance with regulatory and accreditation

    BACKGROUND/EXPERIENCE desired:

    3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.

    Case management and discharge planning experience preferred

    Managed Care experience preferred

    Crisis intervention skills preferred

    Experience doing home visits preferred

    EDUCATION

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

    LICENSES AND CERTIFICATIONS

    Nursing/Registered Nurse (RN) is Required

    Mental Health/Licensed Clinical Social Worker is desired

    FUNCTIONAL EXPERIENCES

    Functional - Customer Service//1-3 Years

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

    ADDITIONAL JOB INFORMATION

    Autonomy, Potential Work at Home with proven productivity, Wellness Benefits

    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.

    Exciting opportunities at Aetna a leader within the Healthcare industry We are having an onsite Career/Job Fair seeking RN, LPN, LPC, LCSW and more Recruiters and hiring managers will be available for onsite interviews We will be at Palmer House Hilton17 East Monroe Chicago, ILJanuary 24, 2017 from 10a to 5p Doubletree Chicago800m National Parkway Schaumburg, ILJanuary 26, 2017 from 10a to 5p Please share and pass along this grand opportunity Remember, you can always visit our website for open opportunities

Job Function: Health Care