Job Details

Clinical-Care-Manager--VA-MCD

Company name
Aetna Inc.

Location
Charlottesville, VA

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The Clinical Care Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members through assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes. Routine field based travel is required with personal vehicle. Qualified candidates must have dependable transportation, valid and active VA driver's license and proof of vehicle insurance.

Fundamental components Include, but are not limited to:

Assessment of Members:

- Through the use of clinical tools and review of member specific health information/data, conducts comprehensive assessments of referred members needs/eligibility and, in collaboration with the members care team, determines an approach to resolving member issues and/or meeting needs by evaluating the members benefit plan and available internal and external programs/services and resources.

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

- Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical and service providers for thorough assessment and 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

- Monitoring, Evaluation and Documentation of Care.

- Certified Case Managers are a plus.

Qualification Requirements:

- 3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.

- One of the following active, unrestricted state clinical licenses

required

: Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), or Licensed Professional Counselor (LPC)

- Case management and discharge planning experience strongly preferred.

- Managed Care experience preferred.

- Crisis intervention skills preferred.

- Bilingual English/Spanish speaking skills are highly desired.

Education:

The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

Licenses and Certifications:

- One of the following active, unrestricted state clinical licenses

required

: Registered Nurse (RN), Licensed Clinical Social Worker (LCSW), or Licensed Professional Counselor (LPC)

- Certified Case Manager (CCM) is preferred.

FUNCTIONAL EXPERIENCES

Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years

Functional - Medical Management/Medical Management - Case Management/4-6 Years

Functional - Medical Management/Medical Management - Managed Care/Insurance Administration/4-6 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User

Technical - Desktop Tools/Microsoft Word/4-6 Years/End User

Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User

Technical - Desktop Tools/Microsoft SharePoint/4-6 Years/End User

Telework Specifications:

WAH is anticipated, timeline for transition to work at home post training completion and demonstrated performance. Positions will require frequent and routine field based travel.

ADDITIONAL JOB INFORMATION

Education and Certification Requirements: Master's degree in behavioral health field; or Registered Nurse is preferred (BSN preferred): and Active unrestricted State Licensure in applicable functional area. (eg RN, LPC, LCSW). Additional background and experience desired: Previous experience conducting face-to-face care management is a plus; qualified candidates must have the ability to support the complexity of members needs including face-to-face visitation Computer literacy and proficiency with Microsoft Excel, Word, including navigating multiple systems and keyboarding Ability to multitask, prioritize and effectively adapt to a fast paced changing environment Knowledge of community resources and provider networks Familiarity with local health care delivery systems Behavioral Health experience is a plus Strong documentation skills Ability to work independently and as part of a team Strong communication skills, written and oral Strong organizational skills. Ability to travel in the field required with personal vehicle. Must possess reliable transportation, valid and active driver's license and proof of insurance required.

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.

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.

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.

Benefit eligibility may vary by position. Click here

to review the benefits associated with this position.

Aetna takes our candidate'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.

Company info

Aetna Inc.
Website : http://www.aetna.com

Company Profile
Aetna Inc. operates as a diversified health care benefits company in the United States. The company operates in three segments: Health Care, Group Insurance, and Large Case Pensions. The Health Care segment provides medical, pharmacy benefit management, dental, behavioral health, and vision plans on an insured basis, and an employer-funded or administrative basis. This segment also provides Medicare and Medicaid products and services, as well as other medical products, such as medical management and data analytics services, medical stop loss insurance, workers' compensation administrative services, and products that provide access to its provider networks in select markets. This segment offers its products and services to multi-site national, mid-sized, and small employers, as well as individual customers. The Group Insurance segment provides life insurance products comprising group term life insurance, voluntary spouse and dependent term life insurance, group universal life, and accidental death and dismemberment insurance; disability insurance products; and long-term care insurance products, which offer benefits to cover the cost of care in private home settings, adult day care, assisted living, or nursing facilities. This segment provides insurance products principally to employers that sponsor its products for the benefit of their employees and their employees’ dependents. The Large Case Pensions segment manages various retirement products, including pension and annuity products for tax-qualified pension plans. The company’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups, and expatriates. Aetna Inc. was founded in 1853 and is headquartered in Hartford, Connecticut.

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