Aetna Case Management Coordinator in Doral, Florida

Req ID: 44397BR

POSITION SUMMARY

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.

Fundamental Components:

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.

BACKGROUND/EXPERIENCE required:

Managed Care experience Case management Coordination experience

Preferred:

1-2 years experience in behavioral health, social services Discharge Planning

EDUCATION

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

FUNCTIONAL EXPERIENCES

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

TECHNOLOGY EXPERIENCES

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

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Understanding Clinical Impacts/FOUNDATION

General Business/Communicating for Impact/FOUNDATION

DESIRED SKILLS

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