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.
Fundamental Components but not limited to the following:
Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
Coordinates and implements assigned care plan activities and monitors care plan progress.
2+ years experience in behavioral health, social services or appropriate related field equivalent to program focus is required
Must be comfortable working over the computer throughout the day
Must be comfortable working independently.
Managed Care experience is preferred
Case management and discharge planning experience is preferred
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Limited License Master Social Worker (LLMSW) required
Licensed Baccalaureate Social Worker (LBSW) required
Functional - Medical Management/Medical Management - Non-profit Community Health Center/1+ Years
Functional - Medical Management/Medical Management - Disease management/4+Years
Functional - Medical Management/Medical Management - Case Management/1+ Years
Technical - Desktop Tools/Microsoft Outlook//End User
Technical - Aetna Applications/QNXT//End User
Technical - Aetna Applications///
Benefits Management/Encouraging Wellness and Prevention/ADVANCED
Benefits Management/Interacting with Medical Professionals/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
We offer you:
Home every night, weekend and holiday!
All major holidays are paid time off, vacation and sick time off is accrued. Full benefits offered including 401(k) and many corporate discounts available. Employees are reimbursed for fees to maintain licensure as well as free CEU’s to maintain licensure. Continuing Education credits are available/provided for RN and a various industry certifications too. Work from home with in-state travel. In addition to annual salary, position has potential for a monthly monetary bonus. Mileage reimbursement is provided per the IRS rate.
Coventry provides laptop, IPhone, fax/scanner/printer, as well as office supplies.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
All employees are expected to embody our values of Excellence, Integrity, Caring and Inspiration in all that they do as an employee. The overall responsibility of the Field Case Manager is to ensure the injured worker receives the best possible care in a timely and efficient manner towards full rehabilitation and return to work.
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.