LexingtonRecruiter Since 2001
the smart solution for Lexington jobs

Case Management Coordinator - Cumberland region

Company: Aetna Inc.
Location: Liberty
Posted on: November 19, 2021

Job Description:

Job Description Sign on bonus up for $3,000 eligible candidates. The Intensive Case Management Coordinator 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 Cumberland region and will cover the following counties: Adair, Bell, Casey, Clay, Clinton, Cumberland, Green, Harlan, Jackson, Knox, Laurel, McCreary, Pulaski, Rockcastle, Russell, Taylor, Wayne, Whitley. . Qualified candidates MUST reside in the assigned region or in a county that is 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 knowledgeably 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. Required Qualifications Required Qualifications : * 6 months 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. * 6 months experience in and knowledge of Behavior Health Services and knowledge of best practice treatment delivery systems for intensive member care needs, social services or appropriate related field equivalent to program focus. * 1 year experience in 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. COVID Requirements COVID-19 Vaccination Requirement CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated. * If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health. * If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated. Preferred Qualifications * Case management and discharge planning experience preferred. * Managed care experience preferred. Education Bachelor's degree in social work, psychology, or equivalent human services field required. Business Overview 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.

Keywords: Aetna Inc., Lexington , Case Management Coordinator - Cumberland region, Executive , Liberty, Kentucky

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Log In or Create An Account

Get the latest Kentucky jobs by following @recnetKY on Twitter!

Lexington RSS job feeds