Title Case Management Coordinator (Central Florida)
Position Summary This role is open to Telework for candidates in FL! Preference for candidates in central Florida area!
Hours: Monday-Friday, 9:00AM-5:00PM EST
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 & Physical Requirements include but are not limited to (* denotes essential functions)
• Evaluation of Members:
-Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s 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.
• 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: 1
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Required Qualifications -2-3+ years experience in a clinical environment (ie. clinical call center, hospital setting, health coach, doctors office, social work)
-Strong communication skills
-Strong technology skills
Preferred Qualifications -Medical case management setting experience behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling).
Education -Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling).
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.
Req ID 1683719BR
Clinical Licensure Required N/A
Job Category Aetna, Behavioral Health, Social Services
Business Area Aetna
Job Type (Expected Hours Category) Full Time
Location - State/City FL - Altamonte Springs, FL - Apopka, FL - Bartow, FL - Brandon, FL - Davenport, FL - Haines City, FL - Lake Mary, FL - Lake Wales, FL - Lakeland, FL - Lutz, FL - Orlando, FL - Oviedo, FL - Plant City, FL - Riverview, FL - Sanford, FL - Tampa, FL - Wesley Chapel, FL - Windermere, FL - Winter Haven, FL - Winter Park, FL - Work from home, FL - Zephyrhills
Location code OF272
Street Address 6204 Benjamin Road Suite 200
City Tampa
State FL
Zip Code 33634
Country United States
FLSA Non Exempt
Requisition Template Professional
Sourcing Requisition No
No. of Positions 3