Aetna Clinical Care Manager in Chicago, Illinois

Req ID: 37968BR

AETNA is having a Clinical JOB FAIR on Tuesday, January 24th and Thursday, January 26th (10AM-6PM both days)-Tuesdays job fair will be held at The Palmer Hilton – 17 East Monroe St Chicago, IL Thursdays job fair will be held at the Doubletree Chicago – 800 National Parkway Schaumburg ILRN s are encouraged to join us!

POSITION SUMMARY

Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members through assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes.

Fundamental Components:

Assessment of Members:

-Through the use of clinical tools and review of member specific health information/data, conducts comprehensive assessments of referred members needs/eligibility and, in collaboration with the members care team, determines an approach to resolving member issues and/or meeting needs by evaluating the members benefit plan and available internal and external programs/services and resources.

Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex clinical indicators which impact care planning and resolution of member issues.

Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical and service 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.

Enhancement of Medical Appropriateness and Quality of Care:

Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits.

Using a holistic approach consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives. Presents cases at case rounds/conferences to obtain a multidisciplinary perspective and recommendations 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.

In collaboration with the member and their care team develops and monitors established plans of care to meet the members goals.

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

Utilizes negotiation skills to secure appropriate options and services necessary to meet members' needs

BACKGROUND/EXPERIENCE:

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

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) or Mental Health/Licensed Clinical Social Worker (LCSW) or Mental Health/Licensed Clinical Professional Counselor (LCPC) is required.

FUNCTIONAL EXPERIENCES

Nursing/Case Management/1-3 Years

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

TECHNOLOGY EXPERIENCES

Computer Operations/System and Console Operations/1-3 Years/End User

Telework Specifications:

Working from home becomes an option based on business needs, and contingent upon meeting criteria.

ADDITIONAL JOB INFORMATION

Looking for an RN, LCSW, or LCPC to join the case management team to perform primarily telephonic case management/care coordination to Medicaid members in the Chicagoland and surrounding area. Previous work and passion for working with this population is highly regarded. The opening is for FHP- Family Health Plan so experience working with families/children is a plus!

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.

Job Function: Health Care