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Case Management Coordinator

Company: Aetna Inc.
Location: Tallahassee
Posted on: August 5, 2022

Job Description:

Job Description

This role is open to Telework for candidates in FL! Preference for candidates in Tampa, Miami and Orlando Florida regions.

Potential for minimal local travel.

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+ years experience in a clinical environment (ie. clinical call center, hospital setting, health coach, doctors office, social work with a behavioral health focus)

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications

Case management setting experience behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling).

* Strong communication skills
* Strong technology skills


* 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

Bring your heart to CVS Health

Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day.

CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Keywords: Aetna Inc., Tallahassee , Case Management Coordinator, Executive , Tallahassee, Florida

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