Aetna Case Management Coordinator in Doral, Florida
Req ID: 44397BR
Utilizes critical thinking and judgment to collaborate with Nurse Case Managers to support the Dual Eligible Special Needs Plans (D-SNP) case management process. Facilitates appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
Assisting members meet their needs by evaluating members benefit plan, care plan and available internal and external programs/services Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of members needs and recommends an approach to case resolution Coordinates and implements assigned care plan activities and monitors care plan progress 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 Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives Identifies and escalates quality of care issues through established channels Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/ behavior changes to achieve optimum level of health Helps member actively and knowledgably participate with their provider in healthcare decision-making.
Managed Care experience Case management Coordination experience
1-2 years experience in behavioral health, social services Discharge Planning
The highest level of education required for candidates in this position is a Associate's degree or equivalent experience.
Functional - Clinical / Medical/Disease management/1-3 Years
Functional - Medical Management/Medical Management - Disease management/1-3 Years
Functional - Medical Management/Medical Management - Case Management/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Understanding Clinical Impacts/FOUNDATION
General Business/Communicating for Impact/FOUNDATION
Benefits Management/Interacting with Medical Professionals/ADVANCED
General Business/Turning Data into Information/FOUNDATION
Leadership/Collaborating for Results/ADVANCED
ADDITIONAL JOB INFORMATION
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