Aetna Case Management Coordinator, LSW in New Albany, Ohio
Req ID: 61528BR
This is an in-office position open to candidates in the New Albany, OH office who hold an active Ohio LSW license. 50-75% travel is involved for face to face visits.
Utilizes critical thinking and knowledge of program requirements, network and community resources, and Medicaid benefits to facilitate appropriate physical and behavioral healthcare and social services for members through collaboration with clinical and p
Fundamental Components included but are not limited to:
Evaluation of Members:
-Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member s 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.
Enhancement of Medical Appropriateness and Quality of Care:
Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
Identifies and escalates quality of care issues through established channels.
-Utilizes negotiation skills to secure appropriate options and services necessary to meet the member s benefits and/or healthcare needs.
- 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. Monitoring, Evaluation and Documentation of Care:
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Qualifications Requirements and Preferences:
2+ years experience in behavioral health, social services or appropriate related field equivalent to program focus required
LSW licensure required
Case management and discharge planning experience preferred
Managed Care experience preferred
Mental Health - Licensed Social Worker (LSW)
Additional Job Information:
Required to do home visits. All charting is done electronically.
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.