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Registered Nurse (RN) / LMSW - Clinical Care Manager [MI DUALS] - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | southfield, Michigan |
About this job
$3000 Sign on Bonus!
Aetna Better Health Premier Plan, a MI Health Link Plan, is looking for caring people who share our vision of helping to provide innovative, community-based health care for dual-eligible Medicare-Medicaid members in Michigan. Aetna Better Health of Michigan is a great place to work. As an employee, not only will you be helping others, youll be part of a team just as dedicated as you. Our company values diversity and is dedicated to helping you achieve your career goals.
POSITION SUMMARY
As an Intensive Long Term Care Management (ILTCM) Clinical Care Manager, you will utilize 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, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes.Please note that regular field-based travel will be required in this role.
FUNDAMENTAL COMPONENTS
- 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
REQUIRED BACKGROUND/EXPERIENCE
- 3-5 years clinical practice experience (ex: hospital setting, alternative care setting such as home health or ambulatory care) required
- Licensed independent BH clinician (Licensed Master Social Worker) in state of service or Registered Nurse with unrestricted RN state license.
PREFERRED BACKGROUND/EXPERIENCE
- Case management and discharge planning experience
- Managed Care experience
- Long Term Services and Support (LTSS), home and community-based services, or Long Term Care (LTC) experience
- Strong crisis intervention skills
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Registered Nurse (RN) license or Licensed Master Social Worker (LMSW) is required to be considered for this role.
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
ADDITIONAL COMPANY INFORMATION
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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Employment Type Regular Career Band Description Professional
Aetna Better Health Premier Plan, a MI Health Link Plan, is looking for caring people who share our vision of helping to provide innovative, community-based health care for dual-eligible Medicare-Medicaid members in Michigan. Aetna Better Health of Michigan is a great place to work. As an employee, not only will you be helping others, youll be part of a team just as dedicated as you. Our company values diversity and is dedicated to helping you achieve your career goals.
POSITION SUMMARY
As an Intensive Long Term Care Management (ILTCM) Clinical Care Manager, you will utilize 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, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes.Please note that regular field-based travel will be required in this role.
FUNDAMENTAL COMPONENTS
- 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
REQUIRED BACKGROUND/EXPERIENCE
- 3-5 years clinical practice experience (ex: hospital setting, alternative care setting such as home health or ambulatory care) required
- Licensed independent BH clinician (Licensed Master Social Worker) in state of service or Registered Nurse with unrestricted RN state license.
PREFERRED BACKGROUND/EXPERIENCE
- Case management and discharge planning experience
- Managed Care experience
- Long Term Services and Support (LTSS), home and community-based services, or Long Term Care (LTC) experience
- Strong crisis intervention skills
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Registered Nurse (RN) license or Licensed Master Social Worker (LMSW) is required to be considered for this role.
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User
ADDITIONAL COMPANY INFORMATION
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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Employment Type Regular Career Band Description Professional
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