Aetna Case Management Coordinator Behavioral Health Tidewater, VA in Norfolk, Virginia

Req ID: 52085BR

Must reside in & near to Tidewater, VA.

POSITION SUMMARY

The Case Management Coordinator services Aetna Better Health of Virginia members; utilizes critical thinking and judgment to collaborate and inform the service coordination process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of service coordination tools and resources.

Fundamental Components but not limited to the following:

Through the use of service coordination tools and information/data review, conduct comprehensive evaluation of referred members needs/eligibility and recommend an approach of 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.

-Enhancement of medical appropriateness and quality of care. -Identifies and escalates quality of care issues through established channels.

-Helps members actively and knowledgably participate with their provider in healthcare decision-making.

BACKGROUND/EXPERIENCE:

Managed Care experience preferred

Case management and discharge planning experience preferred

2 years experience in behavioral health, social services or appropriate related field equivalent to program focus required

EDUCATION

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

LICENSES AND CERTIFICATIONS

Managed Care/Certified Managed Care Nurse, CMCN is desired

Managed Care/Managed Healthcare Professional is desired

FUNCTIONAL EXPERIENCES

Functional - Clinical / Medical/Disease management/1-3 Years

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

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

REQUIRED SKILLS

General Business/Communicating for Impact/FOUNDATION

DESIRED SKILLS

Benefits Management/Encouraging Wellness and Prevention/ADVANCED

Benefits Management/Understanding Clinical Impacts/FOUNDATION

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 candidate'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