Description: Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. 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: The Case Manager Coordinator is responsible for conducting face to face visits using comprehensive assessments of members enrolled in Managed Long-Term Services and Supports program (MLTSS). The Case Manager Coordinator is responsible to coordinate and collaborate care with member/authorized representative, PCP, and any other care team participant. The Case Manager Coordinator will attend interdisciplinary meetings and advocate on members behalf. The Case Manager Coordinator works with member and care team to develop care plan and will authorize services within the MLTSS benefit. The Case Manager Coordinator will also work with the member and care team to coordinate and assist with community resources. The Case Manager Coordinator is responsible for documenting accurately and timely in the electronic health record. This position requires the care manager to use critical thinking and be able to problem solve any issues related to assigned membership. While this position is telework the care manager must work normal business hours Background Experience: 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus; required Bachelor's degree or non-licensed master level clinician with either degree being in behavioral health or human services such as psychology, social work, marriage and family therapy, counseling; Required Case management and discharge planning experience; preferred Managed Care experience; preferred 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.