Description: Full-time telework opportunity open to applicants in the following LA counties: Lafourche, St. Mary, Terrobonne. 25-50% travel is involved for face to face visits.Functions as a coordinator of care for members identified as having longterm rehabilitation and/or psychosocial needs as a result of birth defects, chronic conditions, illness or injury for members to prevent exacerbations, re-admissions or need for placement into custodial care. Responsible for implementing and coordinating all case management, psychosocial, and quality of life activities relating to cases across the continuum of care including consultant referrals, home care visits, use of community resources and alternative levels of care. Responsible for developing and carrying out strategies to coordinate and integrate all acute and longterm care services to the members, and to those in case and disease management. Provides psychosocial interventions through resource identification, program development and other means. This position may specialize within a disease area and may serve in a consultative role to other health care professionals.63658 Fundamental Components: Responsible for the comprehensive management of members with acute or chronic conditions. Case management activities will focus on quality of care, compliance, outcomes and decreasing costs. Responsible for developing and carrying out strategies to coordinate and integrate all acute and long term care services to members to prevent exacerbations and/or placement of the members in custodial care. Performs initial and periodic assessments of the members enrolled in the Longterm Care Program and/or case or disease management programs. Applies case management concepts, principles and strategies in the development of an individualized case plan for enrolled members in case or disease management that are at risk of poor outcomes.The case plan addresses the member's wide range of needs. The case planning process includes the following actions: assessment, goal setting, establishing interventions related to goals, monitoring success of the interventions, evaluating the success of the overall case plan and reporting outcomes. Conducts regular discussion and updates with providers, primary care physicians, Medical Directors, pharmacists, and care management staff regarding the status of particular patients. Serves as a member advocate to ensure the member receives all of the necessary care allowed under the member's benefit plan. Understands healthcare reimbursement methods that promote the provision of cost effective healthcare and the preservation of member benefits. Utilizes community resource ability and alternate funding arrangements available to plan members when services are not available under the benefit package. Develops new programs as appropriate to reduce admissions for acute and chronic members and assist with decreasing inpatient lengths of stay, and preventing avoidable emergency room utilization. Develops relationships with hospital social workers and community resources to assure appropriate care management of catastrophic, acute, and chronically ill members. Assists in the identification and reporting of potential quality improvement issues. Responsible for assuring these issues are reported to the appropriate department.Directs social work interventions including coordinating the distribution, collection, and evaluation of personal health questionnaires to eligible clients, performing psychosocial assessment of the populations, telephone follow-up and in-home or facility assessments as indicated, documentation of problems, assessments, and/or interventions, and promoting ease of access to a continuum of care through appropriate info and referral. For employees providing disease management for Medicaid members, this role is also responsible for implementing and coordinating case management activities related to the use of community resources and behavioral health issues. Provides psychosocial interventions through resource identification, program development, and other means. May serve in a consultative role to other health care professionals. Assists with securing community resources and facilitates transportation as appropriate. Performs other duties as required. Experience Experience: 2+ years experience in medical social work or case management requiredLCSW is required Additional Job Info: Knowledge of the regulations, standards, and policies which relate to social work practice.Knowledge of individual and group behavior and inter-relationships among social, economic psychological and physical factors.Extensive knowledge of community resources.Good knowledge of casework and group work principles, practices, and methodology. Desired Skills: General Business - Applying Reasoned Judgment, Service - Providing Solutions to Constituent Needs, Service - Working Across Boundaries Technology Experience: Desktop Tool - Microsoft Outlook, Desktop Tool - Word, Desktop Tool - TE Ms excel Education: Mental Health - Licensed Clinical Social Worker Potential Telework Position: Yes Percent of Travel Required: ten - 25% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Applicant Privacy Info: Aetna takes our applicant's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal info (Social Security Number, Credit card details for direct deposit, etc.) from you via e-mail. Any requests for details will be discussed prior and will be conducted through a secure web siteprovided by the recruiter. Should you be asked for such info, please notify us immediately.
August 25 on Professional Diversity Network