Case Management Coordinator

Company: Aetna Inc.
Location: Seminole
Posted on: November 18, 2021

Job Description:

Job Description Candidates must be located in Altamonte Springs, Longwood, Casselberry, Lake Mary, FL or the surrounding Seminole Counties. This role will require 50-75% travel for face-to-face visits with members in the Seminole County, FL. Schedule is Monday-Friday, standard business hours. 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. * Conducts comprehensive evaluation of Members using care management tools and information/data review * Coordinates and implements assigned care plan activities and monitors care plan progress * Conducts 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 member's 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. Required Qualifications * 2+ years experience in behavioral health and/or social services or appropriate related field equivalent to program focus * 2+ year computer proficiency in Microsoft Word, Excel, and Outlook * This role will require 50-75% travel for face-to-face visits with members in the Seminole County, FL COVID Requirements COVID-19 Vaccination Requirement CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated. * If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health. * If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated. Preferred Qualifications * Managed care experience * Long-term care experience * Case management and discharge planning experience * Master's degree preferred Education * Bachelor's Degree in Social Work or related field required Business Overview At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart. We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.

Keywords: Aetna Inc., Largo , Case Management Coordinator, Executive , Seminole, Florida