Aetna Clinical Case Manager in Sandy, Utah
Req ID: 51943BR
This role is Monday-Friday 8am-5pm with 1 late night per week.
Candidates external to Aetna will be office based in either Sandy, UT or Blue Bell, PA to start. Candidates internal to Aetna may work from home.
Utilizes advanced clinical judgment, and critical thinking skills, to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.
Fundamental components include but are not limited to:
Assessment of Members: Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred members needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating members benefit plan and available internal and external programs/services. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues. Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes. Identifies and escalates quality of care issues through established workflows. Ability to speak to medical and behavioral health professionals to influence appropriate member care. Utilizes Motivational Interviewing skills to ensure maximum member engagement, and promotes 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. Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
An independent behavioral health license is required
1 year minimum of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
Strong typist & highly organized with ability to quickly prioritize is required
Case management and discharge planning experience preferred
Managed care/utilization review experience preferred
Crisis intervention skills ideal
The minimum level of education desired for candidates in this position is a Master's degree.
LICENSES AND CERTIFICATIONS
One of the following licenses is required:
Licensed Clinical Social Worker
Licensed Mental Health Counselor
Marriage & Family Therapist
Licensed Professional Counselor
Registered Nurse with behavioral health experience
Functional - Clinical / Medical/Disease management/1-3 Years
Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years
Functional - Medical Management/Medical Management - Clinical coverage and policies/1-3 Years
Functional - Medical Management/Medical Management - Direct patient care/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User
Benefits Management/Encouraging Wellness and Prevention/ADVANCED
Benefits Management/Understanding Clinical Impacts/ADVANCED
General Business/Applying Reasoned Judgment/ADVANCED
General Business/Communicating for Impact/FOUNDATION
Leadership/Collaborating for Results/MASTERY
ADDITIONAL JOB INFORMATION
Candidate must be licensed in the state in which they will be working, with at least one candidate needed to be licensed and residing in the State of CA Requires knowledge of mental health and substance abuse disorders Must be able to talk on the telephone and type at the same time Experience using Motivational Interviewing and good technological skills are a plus
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