Clinical Case Manager BH

Aetna Inc. Chester , PA 19013

Posted 1 week ago

Job Description:

Position Summary:

Only applicants willing to conduct home visits in Delaware county will be considered.

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.

Job Responsibilities:

Assessment of Members:

  • Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred members needs/eligibility & determines approach to case resolution and/or meeting needs by evaluating members benefit plan and available internal and external programs/services.

  • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.

  • Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment & treatment, as clinically indicated.

  • Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.

Enhancement of Medical Appropriateness and Quality of Care:

  • Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, & regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits

  • Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes

  • Identifies and escalates quality of care issues through established channels

  • Ability to speak to medical and behavioral health professionals to influence appropriate member care.

  • Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes 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

  • Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.

Monitoring, Evaluation and Documentation of Care:

  • In collaboration with the member and their care team develops and monitors established plans of care to meet the members goals

  • Utilizes case management & quality management processes in compliance with regulatory and accreditation guidelines & company policies & procedures.

Background/ Experience Desired:

  • 3-5 years of direct clinical practice experience post master's degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility

  • Case management and discharge planning experience preferred

  • Managed care/utilization review experience preferred

  • Crisis intervention skills preferred

Education:

The highest level of education desired for candidates in this position is a Master's degree.

Licensures/ Certifications:

Licensed Clinical Social Worker (LCSW) in state of PA; active and in good standing required.

Additional Job Information:

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

Aetna takes our candidates'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.


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Case Manager II

Diakon Lutheran Social Ministries

Posted 5 days ago

VIEW JOBS 4/18/2019 12:00:00 AM 2019-07-17T00:00 Diakon Lutheran Social Ministries is one of the premier employers in Pennsylvania and Maryland. We are a non-profit organization which includes Diakon Senior Living Services and Diakon Child, Family, and Community Ministries. # General Responsibilities: Provide full range of in-depth social work services, including case management to client population in accordance with state regulations and agency policies. # Employs a range of social work interventions with client families to facilitate accomplishments of goals listed in the Service Plan. Makes initial case assessment and ongoing assessments.# Provides case management and face-to-face services as described in Service Plan, to meet stated client goals. # Education/Training: A bachelor#s degree in social work, BSW, normally required.# # Experience: A minimum of two (2) years# experience in a related child welfare or human service position normally required. #Experience in social work or case management is essential. # ADA: Ability to sit, stand, bend, stoop, reach, and lift items weighing up to 50 lbs.; visual and auditory skills. # Diakon offers a competitive compensation and benefits package for employees including Medical, Dental, Vision, and Prescription Drug coverage. We also offer voluntary short-term disability, long-term disability, life insurance, tuition assistance, 401(k) plan with Employer Match, and paid time off.# # Diakon is an equal opportunity employer. EOE/M/F/VETS/Disabled Diakon Lutheran Social Ministries Chester PA

Clinical Case Manager BH

Aetna Inc.