Aetna Social Worker in Alpharetta, Georgia
Req ID: 65786BR
Full time telework opportunity open to candidates in the following GA counties: Cobb, Fulton, Dekalb, Gwinett, Forsyth, Clayton. 25-50% travel is involved for face to face visits.
Functions as a coordinator of care for members identified as having long-term rehabilitation and/or psychosocial needs as a result of birth defects, chronic conditions, illness or injury for members to prevent exacerbations, re-admissions or need for placement into custodial care. Responsible for implementing and coordinating all case management, psychosocial, and quality of life activities relating to cases across the continuum of care including consultant referrals, home care visits, use of community resources and alternative levels of care. Responsible for developing and carrying out strategies to coordinate and integrate all acute and long-term care services to the members, and to those in case and disease management. Provides psychosocial interventions through resource identification, program development and other means. This position may specialize within a disease area and may serve in a consultative role to other health care professionals.
Fundamental Components included but are not limited to:
Responsible for the comprehensive management of members with acute or chronic conditions. Case management activities will focus on quality of care, compliance, outcomes and decreasing costs. Responsible for developing and carrying out strategies to coordinate and integrate all acute and long-term care services to members to prevent exacerbations and/or placement of the members in custodial care. Performs initial and periodic assessments of the members enrolled in the Long-Term Care Program and/or case or disease management programs. Applies case management concepts, principles and strategies in the development of an individualized case plan for enrolled members in case or disease management that are at risk of poor outcomes. The case plan addresses the member s broad spectrum of needs. The case planning process includes the following actions: assessment, goal setting, establishing interventions related to goals, monitoring success of the interventions, evaluating the success of the overall case plan and reporting outcomes. Conducts regular discussion and updates with providers, primary care physicians, Medical Directors, pharmacists, and care management staff regarding the status of particular patients. Serves as a member advocate to ensure the member receives all of the necessary care allowed under the member s benefit plan. Understands healthcare reimbursement methods that promote the provision of cost effective healthcare and the preservation of member benefits.
Utilizes community resource expertise and alternate funding arrangements available to plan members when services are not available under the benefits program. Develops new programs as appropriate to reduce admissions for acute and chronic members and assist with decreasing inpatient lengths of stay, and preventing avoidable emergency room utilization. Develops relationships with hospital social workers and community resources to assure appropriate care management of catastrophic, acute, and chronically ill members. Assists in the identification and reporting of potential quality improvement issues. Responsible for assuring these issues are reported to the appropriate department. Directs social work interventions including coordinating the distribution, collection, and evaluation of personal health questionnaires to eligible clients, performing psychosocial assessment of the populations, telephone follow-up and in-home or facility assessments as indicated, documentation of problems, assessments, and/or interventions, and promoting ease of access to a continuum of care through appropriate information and referral. For employees providing disease management for Medicaid members, this role is also responsible for implementing and coordinating case management activities related to the use of community resources and behavioral health issues. Provides psychosocial interventions through resource identification, program development, and other means. May serve in a consultative role to other health care professionals. Assists with securing community resources and facilitates transportation as appropriate. Performs other duties as required.
Qualifications Requirements and Preferences:
Minimum of 2+ years experience in medical social work or case management required
LSW, LMSW or LCSW required
Mental Health - Licensed Master Social Worker (LMSW), Mental Health - Licensed Social Worker (LSW)
Additional Job Information:
Knowledge of the regulations, standards, and policies which relate to social work practice.Knowledge of individual and group behavior and inter-relationships among social, economic psychological and physical factors.Extensive knowledge of community resources.Thorough knowledge of casework and group work principles, practices, and methodology.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Healthcare
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.