Aetna Social Worker (LCSW) in Albuquerque, New Mexico

Req ID: 54554BR

This role is telework with 75-100% of field based travel in Albuquerque, NM.

POSITION SUMMARY

This is your opportunity to join an organization that is reshaping healthcare! Aetna is about meeting our members where they are and working to improve their lives, one person at a time!

Come help us make a difference!

*Candidates must be willing and able to travel daily in Albuquerque, New Mexico area.

Fundamental components include but are not limited to:

The Social Worker, works within a Care Team setting, and is responsible for supporting member-centered care management across the health care continuum, to ensure services are being provided to, members and their families. Provides assessments that address social and behavioral health outcome indicators. Addresses social determinants of health and actively participates in the members plan of care, to promote effective utilization of plan benefits, available resources, supports optimal member functioning, while assuring cost-effective outcomes.

Job Responsibilities:

  • Utilizes professional clinical judgment and advanced clinical skills in completing assessments of referred member needs/review of member-specific health information; determines an approach to resolve member issues/meeting needs by evaluating the members benefit plan & available internal/external programs/services/resources

  • Incorporates strategies designed to reduce risk factors & barriers; address clinical indicators & barriers which impact care planning/resolution of member issues

  • Prioritizes members experiencing acute behavioral health/medical issues & refers to the appropriate clinical/service providers for thorough assessment & treatment

  • Conducts in person assessments & consultations with members/families

  • Provides crisis follow up to members and their families to ensure they are receiving the appropriate treatment and services

  • Makes timely contact with the Member; provides services in accordance with the approved Social Work policy and documents all communications within 24 hours of member contact

  • Using a holistic approach consults with clinical colleagues, managers, Medical Directors, other ICT members & other programs to overcome barriers to meeting goals/objectives.

  • Collaborates w/medical & behavioral health professionals and present cases at case rounds to coordinate member care

  • Identifies/escalates member safety & quality of care issues through established

  • Utilizes influencing/motivational interviewing skills to ensure maximum member engagement; promotes lifestyle/behavior changes to achieve optimum level of health

  • Provides coaching, information & support to empower the member to make ongoing independent medical/healthy lifestyle choices and fully participate w/their provider in healthcare decision-making

-Maintains a comprehensive working knowledge of community resources, payer requirements and network services

BACKGROUND/EXPERIENCE

  • The minimum level of education required for candidates in this position is a Master's degree

  • Licenses/ Certifications: Licensed Clinical Social Worker (LCSW); active and in good standing is required

  • 3+ years clinical practice experience, e.g., community, public health, hospital setting, alternative care setting such as home health or ambulatory care required

  • Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications required

  • Ability to travel within a designated geographic area required

  • Case management, behavioral health, discharge planning experience preferred

  • Managed Care, Medicare/Medicaid experience preferred

  • Crisis intervention skills preferred

  • Bilingual (Spanish, Creole and/or Vietnamese) preferred

EDUCATION

The minimum level of education desired for candidates in this position is a Master's degree.

LICENSES AND CERTIFICATIONS

Mental Health/Licensed Clinical Social Worker is required

FUNCTIONAL EXPERIENCES

Functional - Medical Management/Medical Management - Case Management/4-6 Years

Functional - Medical Management/Medical Management - Hospice/1-3 Years

Functional - Medical Management/Medical Management - Discharge planning/1-3 Years

Functional - Medical Management/Medical Management - Clinical coverage and policies/1-3 Years

Functional - Medical Management/Medical Management - Home health care/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Remote Access/WAH (Work at Home)/1-3 Years/End User

Technical - Call Management//1-3 Years/End User

Technical - Telecommunications//1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Encouraging Wellness and Prevention/ADVANCED

Benefits Management/Maximizing Healthcare Quality/ADVANCED

Benefits Management/Understanding Clinical Impacts/ADVANCED

DESIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

General Business/Applying Reasoned Judgment/ADVANCED

Leadership/Collaborating for Results/MASTERY

Telework Specifications:

Telework is a requirement for this position (no physical office location). Time will be split between working at home and visiting members in the field.

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 candidates'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

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.