Healthcare Case manager
📋 Role Overview & Responsibilities
Duration: 02 months contract, Full-Time
Employment Type: W-2
Position Summary: This will be a full-time telework role in Kansas, however, will require 50-75% travel for face-to-face visits in assigned area once COVID restrictions are lifted. Schedule is Monday-Friday, standard business hours. Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. 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 andeducation for members through the use of care management tools and resources.
Responsibilities:- Through the use of care management tools and information/data review, conducts comprehensiveevaluation of referred member's needs/eligibility and recommends an approach to case resolution and/ormeeting 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 planningcomponents 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 healthprograms to overcome barriers to meeting goals and objectives; presents cases at case conferences toobtain 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.
Experience:- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement andpromote lifestyle/behavior changes to achieve optimum level of health.- Provides coaching, information and support to empower the member to make ongoing independentmedical and/or healthy lifestyle choices.- Helps member actively and knowledgably participate with their provider in healthcare decision-making.Monitoring, Evaluation and Documentation of Care:- Utilizes case management and quality management processes in compliance with regulatory andaccreditation guidelines and company policies and procedures
Education:behavioral health, social services, or human services field.Case Management
Skills:behavioral health, Case management
About US Tech Solutions:US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.
Recruiter Details:Name: ParthEmail: p.sahni@ustechsolutionsinc.comInternal Id: 24-04765
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This position is located in Topeka, KS with potential relocation and sponsorship assistance depending on candidate qualifications.
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