Req ID: 14750BR
Candidates are required to have experience working with: Addictive and Dysfunctional Families, Racial and Ethnic Minorities, Homosexual and Bisexual Individuals, Persons with HIV or AIDs, and Substance UsersThis position requires around 50% of travel - candidate is required to have the use of a working and insured vehicle, and a valid driver's license.Dedicated travel to facilities and members' homes in North West Cook County and DuPage County, specifically in the Schaumburg, Arlington Heights, Bartlett, Elgin, Cary, and Crystal Lake areas.POSITION SUMMARYUtilizes 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. Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.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.EDUCATIONThe minimum level of educationrequiredfor candidates in this position is a Bachelor's degree in a human services field (Psychology, Sociology, Social Work, Rehabilitation Services, Health Services, etc).FUNCTIONAL EXPERIENCESFunctional - Medical Management/Case Management/1-3 YearsFunctional - Medical Management/Managed Care/Insurance Clinical Staff/Medicaid/1-3 YearsFunctional - Communications/Member communications/Long Term Care (LTC)/1-3 YearsTECHNOLOGY EXPERIENCESTechnical - Operating Systems/Windows/4-6 YearsTechnical - Desktop Tools/Microsoft Word/4-6 YearsTechnical - Desktop Tools/Microsoft Outlook/1-3 YearsREQUIRED SKILLSLeadership/Driving a Culture of ComplianceGeneral Business/Consulting for SolutionsBenefits Management/Maximizing Healthcare QualityDESIRED SKILLSBenefits Management/Understanding Clinical ImpactsGeneral Business/Communicating for ImpactTechnology/Leveraging TechnologyPlease note that benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Aetna does not permit the use of tobacco related products or drugs in the workplace.
Job Function: Health Care