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Aetna Inc.

Behavioral Health Case Manager

Aetna Inc. - Chantilly, VA

POSITION SUMMARY

This is a behavioral health case manager position which consist of working telephonically with members/patients. Our case managers utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals health needs and/or benefit plan through communication and available resources to promote optimal, cost-effective outcomes.

Fundamental Components:

The ideal candidate is experienced in the field of behavioral health case management with a history of employment in managed care or insurance in addition to a clinical background. Fundamental Components: -Apply data driven methods of identification of members and be accountable to follow appropriate procedures for identifying, screening and assessing member needs. -Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services -Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. -Conduct telephonic individualized clinical assessments of member's health concerns/needs and develop a personalized plan of care. -Screen members to identify opportunities for health services, modifiable risk factors and educational needs and provide appropriate partner referrals. -Intervene to positively affect healthcare outcomes. -Evaluate the member's progress in setting and meeting established goals and revise their individualized care plan accordingly.

BACKGROUND/EXPERIENCE required:

ASN required

Requires an active, unrestricted RN license

3-5 years behavioral health case management experience

4-6 years clinical practice experience (discharge planning, disease management, med surg, ICU/CCU & ER)

Certified Case Manager (CCM) or other URAC recognized certification

Motivational Interviewing -Excellent verbal and written communication skills

Proficiency in use of computer applications and keyboarding skills

EDUCATION

The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

BSN prefers

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse (RN) is required

Nursing/Certified Case Manager (CCM) is desired

FUNCTIONAL EXPERIENCES

Functional - Nursing/Mental Health/4-6 Years

Functional - Nursing/Case Management/1-3 Years

Functional - Nursing/Discharge Planning/1-3 Years

Functional - Nursing/Disease management/4-6 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Explorer/1-3 Years/End User

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Understanding Clinical Impacts/FOUNDATION

Leadership/Collaborating for Results/ADVANCED

DESIRED SKILLS

General Business/Applying Reasoned Judgment/ADVANCED

Leadership/Driving a Culture of Compliance/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

Telework Specifications:

Internal candidates are encouraged to apply WAH. Considered for any US location; training period in the office may be required.

ADDITIONAL JOB INFORMATION

Facilitate positive behavior change for members to improve their health. Communicate, problem solve and work effectively with people; use good judgment in new and challenging situations. Utilize motivational interviewing techniques, active listening skills, the Transtheoretical Model, mindfulness based and other evidence-based coaching techniques. Use your clinical decision making, coaching and motivational skills to support our members. Work within a multidisciplinary team.

Full-time position; work hours vary from 8:30 am - 8:00 pm Monday-Friday and 9:00 am - 2:00 pm on Saturday; 2 evening shifts per week and occasional Saturday shifts maybe required in the future. Weekends are not mandatory at this time seeking volunteers. The possibility to work 11:30am - 8 pm Monday-Friday.

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.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here

to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

8 days 16 hours ago

Aetna Inc.

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Behavioral Health Case Manager Aetna Inc. - Chantilly, VA, United States

   

Location: Chantilly, VA

Company Profile:
Aetna Inc. operates as a diversified health care benefits company in the United States. The company operates in three segments: Health Care, Group Insurance, and Large Case Pensions. The Health Care segment provides medical, pharmacy benefit management, dental, behavioral health, and vision plans on an insured basis, and an employer-funded or administrative basis. This segment also provides Medicare and Medicaid products and services, as well as other medical products, such as medical management and data analytics services, medical stop loss insurance, workers' compensation administrative services, and products that provide access to its provider networks in select markets. This segment offers its products and services to multi-site national, mid-sized, and small employers, as well as individual customers. The Group Insurance segment provides life insurance products comprising group term life insurance, voluntary spouse and dependent term life insurance, group universal life, and accidental death and dismemberment insurance; disability insurance products; and long-term care insurance products, which offer benefits to cover the cost of care in private home settings, adult day care, assisted living, or nursing facilities. This segment provides insurance products principally to employers that sponsor its products for the benefit of their employees and their employees’ dependents. The Large Case Pensions segment manages various retirement products, including pension and annuity products for tax-qualified pension plans. The company’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups, and expatriates. Aetna Inc. was founded in 1853 and is headquartered in Hartford, Connecticut.