Aetna Case Management Coordinator in Kalamazoo, Michigan
Req ID: 52529BR
Please note: telework is considered for any candidate residing in the western Michigan area; training period in the office may be required
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.
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.
2+ years experience in behavioral health, social services or appropriate related field equivalent to program focus is required
Must be comfortable working over the computer throughout the day
Must be comfortable working independently.
Managed Care experience is preferred
Case management and discharge planning experience is preferred
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
Licensed Baccalaureate Social Worker (LBSW) required
Functional - Medical Management/Medical Management - Non-profit Community Health Center/1+ Years
Functional - Medical Management/Medical Management - Disease management/4+Years
Functional - Medical Management/Medical Management - Case Management/1+ Years
Technical - Desktop Tools/Microsoft Outlook//End User
Technical - Aetna Applications/QNXT//End User
Technical - Aetna Applications///
Benefits Management/Encouraging Wellness and Prevention/ADVANCED
Benefits Management/Interacting with Medical Professionals/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
Considered for any candidate residing in the western Michigan area; training period in the office may be required
ADDITIONAL JOB INFORMATION
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. Assist members improve healthy outcomes.
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