Aetna Community Health Educator in San Antonio, Texas
Req ID: 49087BR
We are building an exciting new clinical and member experience program at Aetna. Aetna Community Care is a member centric, team-delivered, community based care management model that joins members where they are. The Community Health Educator possesses a broad working knowledge of community resources and is responsible in supporting member-centered care management across the health care continuum. The Community Health Educator works within with the inter-disciplinary care team, in providing coordinated services for ACC members. Community Health Educators will work with Commercial and Medicare Advantage members and their families. They will address members resource needs and effectively utilize community resources, plan benefit resources and actively contribute to the plan of care to promote members well-being by participating in providing cost effective outcomes.
Identifies and escalates safety and quality of care issues that are in accordance with the Procedure, Conduct and Safety for Face to Face Visits. Utilizes knowledge and experience of assigned Zone to contribute and secure resources that address the members needs Actively contributes of the resource directory and reviews content for accuracy and services in each respective zone Contributes to the members plan of care and health outcomes. Identifies Problems, creates goals and interventions that are congruent with Members needs and approval. Community Health Educator is an active participant in the inter-disciplinary care team , attends case reviews and rounds as appropriate and when requested Helps member actively participate with their provider and the care team regarding decisions that impact their health care Adheres to care management, privacy and confidentiality, and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures Documents all communications through, Case Logs, Case Notes and Care Plan, with Members in the Med Compass Platform System. Adheres to documentation policies of within 24 hours of member contact. Reviews work prior to documentation in Med-Compass. Reviews for accuracy, and that information entered is specific to work performed on behalf of the Member. Provides data, and other case information as requested by the Program Manager and other Senior Members of the Leadership Team. Responds to Program Manager and other members on the Senior Leadership team upon request Reviews and Responds within 24 hours to any corrective action on a members file that is conducted routinely through a quality improvement process. Actively utilizes ACC Policies and Procedures and implements best practices by following documented procedures through ACC SharePoint.
Comprehensive working knowledge of community resources (e.g. faith based/nonprofit services) for Commercial & Medicare Advantage population Ability to travel within a designated geographic area to conduct home visits required Ability to flex work hours at times to meet member needs required Community health/public health experience preferred Managed care/Medicare/Medicaid experience preferred Experience in a healthcare setting and medical terminology preferred e.g. Certified Nurses Aid Bilingual, Spanish preferred The minimum level of education required for candidates in this position is a High School Diploma or minimum of 2 years equivalent experience Associate's degree in Social Work, Psychology, Human Services or Health Education preferred
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
Zone 21 - San Antonio
ADDITIONAL JOB INFORMATION
Additional Job Responsibilities:
Applies a working knowledge of community resources in order to identify and connect members to appropriate assistance, coordinating these resources with members eligible benefits and other health plan programs
Effectively uses the community resource directory and approved websites and other approved sources of information to identify additional help for the member.
Provides the member with timely information via phone or mail to address the requested resource needs that are outlined in, the Community Health Education process.
Supports the member and family in any application processes as needed
Confers with agencies and organizations to gain clarity or obtain further details about the resources
Conducts follow up contact with the member to determine disposition of resource use and value to the member
Conducts health support calls upon request of the Field Care Manager; may require face to face visits with members
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