Aetna Clinical Case Manager BH (LCSW) in Sarasota, Florida

Req ID: 52540BR

The Social Worker, works within an Interdisciplinary Care Team setting, and is responsible in supporting member-centered care management across the health care continuum, to ensure services are being provided to, members and their families. Provides assessments that address social and behavioral health outcome indicators. Addresses social determinants of health and actively participates in the members plan of care, to promote effective utilization of plan benefits, available resources, supports optimal member functioning, while assuring cost-effective outcomes.

Additional Job Responsibilities:

Assessment of members through use of clinical tools/review of member-specific health information and dataUtilizes professional judgment in completing Assessments in the Med-Compass SystemConducts comprehensive assessments of referred members needs/eligibility and in collaboration with the members Interdisciplinary Care Team (ICT) determines an approach to resolve member issues/meeting needs by evaluating the members benefit plan & available internal and external programs/services/resourcesApplies clinical judgment to incorporate strategies designed to reduce risk factors & barriers; address clinical indicators & barriers which impact care planning and resolution of member issuesConducts in person assessments & consultations with members/familiesProvides crisis follow up to members and their families to ensure they are receiving the appropriate treatment and services. Involves other members of the Interdisciplinary Care Team (ICT) and documents follow up in Med Compass systemMakes timely contact with the Member and provides services in accordance with the Management 8 Procedure, Engaging with a Social WorkerUtilizes influencing/motivational interviewing skills to ensure maximum member engagement; promotes lifestyle/behavior changes to achieve optimum level of healthIn collaboration with the member & ICT, develops & monitors established plans of care to meet the members goalsAdheres to care management requirements for Aetna Community Care (ACC)Background/Experience:

Minimum of 3+ years of clinical experience required (community, public health, hospital setting, alternative care setting such as home health or ambulatory care strongly preferred)Ability to travel within a designated geographic area requiredProficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applicationsCase management, behavioral health, discharge planning experience preferredManaged Care, Medicare/Medicaid experience preferredCrisis intervention skills preferredBilingual (Spanish) preferredEducation:

The minimum level of education required for candidates in this position is a Master's degree or equivalent experience Licenses and Certifications:

Licensed Clinical Social Work (LCSW) with active state license in good standing required Telework Specifications:

This is a work from home position, but the successful candidate will be responsible for traveling within one of the below listed geographical areas:Sarasota, Manatee, Charlotte and Desoto Counties


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.

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Job Function: Health Care