Aetna TX MCD Service Coordinator I in Arlington, Texas
Req ID: 36164BR
Routine field-based travel with personal vehicle is required in the Tarrant Service area. Residency in the following counties is strongly preferred; Wise, Denton, Parker, Tarrant, Hood and Johnson. The Service Coordinator I, utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members through assessment and member-centered care planning and service coordination, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes.
-Assessment of Members: -Through the use of clinical tools and review of member specific health information/data, conducts comprehensive assessments of referred members needs/eligibility and, in collaboration with the members care team, determines an approach to resolving member issues and/or meeting needs by evaluating the members benefit plan and available internal and external programs/services and resources. -Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex clinical indicators which impact care planning and resolution of member issues. Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical and service providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services. Enhancement of medical appropriateness and quality of care. -Monitoring, evaluation and documentation of Care. In collaboration with the member and the members identified, care team develops and monitors established plans of care to meet the members goals. Adheres to service coordination and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Bilingual skills a plus, Spanish. Computer literacy and proficiency with Microsoft Excel, Word, including navigating multiple systems and keyboarding. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. Strong documentation skills. Ability to work independently and on a team. Strong communication and organization skills,
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is desired
Mental Health/Licensed Clinical Social Worker is desired
Mental Health/Licensed Master Social Worker (LMSW) is desired
Nursing/Advanced Practice Nurse is desired
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Aetna Applications/QNXT/1-3 Years/End User
Position may be considered for WAH, after 9-12 months of demonstrated performance and quality. Field based travel is required.
ADDITIONAL JOB INFORMATION
BACKGROUND/EXPERIENCE desired: Long Term Services and Support experience is required. 3-5 years clinical practice experience in a home, community based services or long term care setting.. Previous service coordination or case management experience. Discharge planning experience is preferred. Crisis intervention skills preferred. Case Management certification is a plus. Previous experience conducting face-to-face care management is a plus; qualified candidates must have the ability to support the complexity of members needs including face-to-face visitation. Knowledge of community resources and provider networks. Familiarity with local health care delivery systems. Behavioral Health experience is a plus. LICENSES AND CERTIFICATIONS Must have one of the following unrestricted licenses in the state of TX: Registered Nurse (RN) Advanced Nurse Practitioner (NP) Licensed Social Workers must be (LCSW) or (LMSW). Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Texas is looking for people like you who value excellence, integrity, caring and innovation. As an employee, youll join a team dedicated to improving the lives of Texas STAR Kids. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Texas, and we will support you all the way.
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.
Job Function: Health Care