Description: Candidates must be located in or near Cherry Hill, NJ or Camden, NJ.
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 Care Planner possesses a broad working knowledge of community resources and is responsible in supporting member-centered care management across the health care continuum. The Care Planner works within with the inter-disciplinary care team, in providing coordinated services for ACC members. Care Planners 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.
Fundamental Components: -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. -Contributes to the members plan of care and health outcomes. Identifies Problems, creates goals and interventions that are congruent with Members needs and approval. -Active participant in the inter-disciplinary care team, attends case reviews and ICT calls 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 Supervisor, Clinical Health Services and other Senior Members of the Leadership Team. Responds to Supervisor, Clinical Health Services 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. Background Experience: 4+ years experience in the medical field required 2+ years experience in behavioral health or medical case management experience required Ability to travel within a designated geographic area to conduct home visits required
Comprehensive working knowledge of community resources (e.g. faith based/nonprofit services) for Commercial & Medicare Advantage population Ability to flex work hours at times to meet member needs Community health/public health experience preferred Managed care/Medicare/Medicaid experience preferred Experience in a healthcare setting and medical terminology preferred e.g. Potential Telework Position: Yes Percent of Travel Required: 50 - 75% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: 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.