Aetna Bilingual Case Management Coordinator in Sunrise, Florida
Req ID: 52671BR
Bilingual in Spanish - Required
50% travel around Miami Dade County
Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate
appropriate healthcare outcomes for members by providing care coordination, support and education for members
through the use of care management tools and resources.
Evaluation of Members:
-Through the use of care management tools and information/data review, conducts
comprehensive evaluation of referred members needs/eligibility and recommends an approach to 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:- 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 members benefits and/or
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.
Bilingual in Spanish - Required
2+ years experience in behavioral health, social services or appropriate related field equivalent to program focus - Required
Bachelor's degree - Required
Managed Care experience preferred
Case management and discharge planning experience preferred
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Microsoft Office experience - required
Technical - Computer Operations///
Technical - Desktop Tools///
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.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidates'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