Aetna Clinical Care Manager in Phoenix, Arizona
Req ID: 39008BR
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.
Through the use of clinical tools and review of member specific health information/data, conducts comprehensive assessments of referred member's needs in collaboration with the clinical team. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address clinical indicators which impact care planning and resolution of member issues. Using a holistic approach consults with clinical colleagues, supervisor, medical directors and/ or other programs to overcome barriers to meeting goals and objectives. Ability to speak to medical and behavioral health professionals to influence appropriate member care. Utilizes motivational interviewing skills to ensure engagement of clinical care team in an integrative model of healthcare service delivery. Provides coaching, information and support to the clinical care team. Analyzes all utilization and clinical data available to consolidate information and begin to identify comprehensive member needs. In collaboration with the clinical care team, develops and monitors care plans to meet the member's goals. Adheres to care management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Identifies and escalates quality of care issues through established channels.
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
Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Licensure Required- Nursing/ - AZ Registered Nurse, orMental Health/AZ - (LCSW) Licensed Clinical Social Worker, (LPC) Licensed Professional Counselor or (LMFT) Licensed Marriage Family Therapist
FUNCTIONAL EXPERIENCESMedical Management/Medical Management - Discharge planning/1-3 Years
Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/1-3 Years
Medical Management/Medical Management - Case Management/1-3 Years
Medical Management/Medical Management - Disease management/1-3 Years
Nursing/Mental Health/1-3 Years
Desktop Tools/Microsoft Outlook/1-3 Years
Desktop Tools/Microsoft Word/1-3 Years
Desktop Tools/TE Microsoft Excel/1-3 Years
ADDITIONAL JOB INFORMATIONMercy Maricopa Integrated Care offers a unique opportunity and innovative approach to service delivery by integrating the member's physical and behavioral health needs. This position is very autonomous in meeting work load demands and flexibility in time management.
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