Aetna Better Health is hiring for multiple openings across the state/regions of Kentucky. For a full list of our available clinical roles, please click HERE.
The Intensive Care Management Coordinator (CMC) is a field based position. This position utilizes critical thinking and professional judgment to collaborate and support the case management process, in order to facilitate improved healthcare outcomes for members with intensive physical and/or behavioral care needs by providing advocacy, coordination, collaboration, support and education through the use of care management tools and resources.
This position requires routine regional in-state travel 80-90% of the time; use of personal vehicle is required. Qualified candidates must have valid KY driver's license, proof of vehicle insurance, and reliable transportation. Travel to the Louisville office is also anticipated for meetings and training.
This position is assigned to the Jefferson region (Jefferson county). Qualified candidates may reside in or adjacent to the assigned region.
Evaluation of Members:
Through the use of care management tools and information/data review, conducts comprehensive assessments of member's needs/eligibility. Integrates all biopsychosocial information and recommends a holistic approach to supporting the member comprehensive care needs by evaluating and coordinating internal and external programs/services that are available within the member's benefit plan. Identifies and proactively addresses high risk factors and service needs that may impact member outcomes through care planning interventions
Coordinates and implements assigned care plan activities and monitors care plan progress. Provides modifications to care plan to reflect changing needs.
Provide crisis support and stabilization as needed.
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 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.
Experience and detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the Kentucky SKY populations, is required.
Experience in the delivery of Behavior Health Services and knowledge of best practice treatment delivery systems for intensive member care needs.
Minimum of a Bachelor's or Master's degree or a non-licensed master level clinician is required; with either degree being in behavioral health or a relevant human services field of study required(social work, psychology, marriage and family therapy, counseling).
Case management and discharge planning experience preferred.
2 years' experience in behavioral health, social services or appropriate related field equivalent to program focus.
Managed Care experience preferred.
Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm, is required. We are serving the needs of children and families that may require working after school, after work, etc.
Additional Job Information
At Aetna Better Health of Kentucky, we reach beyond ensuring access to quality health care by focusing on resilient healing for children and their families. Our vision is to construct local, regional, and state-level coalitions to create a shared, in-common vision of health promoting and resiliency building approaches, to engage and support children to have membership in a family and community, while services and permanency planning are occurring. By keeping families safely together, children in Kentucky SKY will experience less trauma, which leads to better outcomes. To accomplish this, we are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you'll join a team dedicated to supporting children, young people, parents, and other important partners involved with child protection systems. We value diversity and are dedicated to helping you achieve your career goals.
Bachelor's degree or equivalent experience
Percent of Travel Required
75 - 100%
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.