Aetna West New York, NJ

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Req ID: 65736BR

Job 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 included but are not limited to:

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

Qualifications Requirements and Preferences:

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

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Healthcare

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

Associated topics: addiction, advocate, behavioral health, case, coordinator, domestic, lmsw, msw, substance, violence * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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