Case Management Coordinator - Telephonic

Job Description
Sign Up now for Aetna National Clinical Hiring Event! Aetna is growing and working to hire clinicians to support current and future clinical in all lines of our managed care business, including Commercial (Employer) contracts, Medicare, Medicaid and Utilization Management. We are hiring RNs, Social Workers (licensed Behavioral Health clinicians), and Case Management Coordinators with social services experience. This virtual event is on Nov 9th from 9-3pm EST. If interested in learning more or to RSVP, please clicking on this link: http://adtrk.tw/tp/rj6_cJEIU-I.K

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

Position Summary/Mission: The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources.

Fundamental Components
* Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of 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 healthcare needs.
* 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.

Pay Range
The typical pay range for this role is:
Minimum: 19.50
Maximum: 38.99

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
Minimum 2 years of experience in behavioral health, social services or human services field.

Preferred Qualifications
Case management and discharge planning experience preferred

-Managed Care experience preferred

-Microsoft Office experience preferred

Education
Bachelors degree or non-licensed master level clinician
required, with either degree being in behavioral health or
human services required (psychology, social work,
marriage and family therapy, counseling)

Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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