Aetna Case Management Coord in Princeton, New Jersey
Req ID: 38062BR
The Care Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
Care management of Aetna Members through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. - Coordinates and implements assigned care plan activities and monitors care plan progress. Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote 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. Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Managed Care experience preferred Case management and discharge planning experience preferred 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus Excellent Computer Skills in outlook, excel and word documentation. College graduate or some college experience acceptable.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Functional - Customer Service/Customer Service - Member Services - HMO products/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Benefits Management/Encouraging Wellness and Prevention/ADVANCED
Benefits Management/Understanding Clinical Impacts/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
Leadership/Collaborating for Results/ADVANCED
General Business/Communicating for Impact/FOUNDATION
Option for telework will be evaluated after training is completed and certain period of employment is completed. Office-based schedule (must live near office location)
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 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