Aetna Case Management Coordinator in Detroit, Michigan

Req ID: 52530BR

Please note: This is a Full -Time Telework / WAH position in place of office-based. This position will require that the candidate is commutable in the service area in Wayne and Macomb County, MI and this is a field / home based position.

POSITION SUMMARY

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.

Fundamental Components:

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

BACKGROUND/EXPERIENCE desired:

2+ years experience in managed care, home health or appropriate related field equivalent to program focus is required

Managed Care experience is preferred

Case management and discharge planning experience is preferred

EDUCATION

The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Limited License Master Social Worker (LLMSW) required

OR

Licensed Baccalaureate Social Worker (LBSW) required

FUNCTIONAL EXPERIENCES

Functional - Medical Management/Medical Management - Case Management/1+ Years

Functional - Medical Management/Medical Management - Disease management/1+ Years

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

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

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Explorer/1+ Years/End User

Technical - Desktop Tools/Microsoft Outlook/1+ Years/End User

TechnicalExperience/TechnicalFocus/1+ Years/End User

REQUIRED SKILLS

Benefits Management/Understanding Clinical Impacts/FOUNDATION

General Business/Applying Reasoned Judgment/ADVANCED

General Business/Communicating for Impact/FOUNDATION

DESIRED SKILLS

Benefits Management/Encouraging Wellness and Prevention/ADVANCED

Benefits Management/Interacting with Medical Professionals/ADVANCED

Telework Specifications:

  • Full-Time Telework / WAH position in place of office-based.

  • This position will require that the candidate is commutable in the service area in Wayne and Macomb County.

  • This is a field / home based position.

    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.

    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