This Analyst, Case Management position is with Aetna’s Long-Term Services and Supports (LTSS) team and is a field-based position out of Roanoke, Salem, Pearisburg, Narrow, New Castle, Staffordsville or Buchanan VA. The requirements is for candidates to travel 70-75% of the time to meet with members face to face. Case Manager Analyst is responsible for face to face and telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Develops a proactive course of action to address issues presented to enhance the short and long- term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies. Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. Productivity and quality expectations. Work requires the ability to perform close inspection of handwritten and computer-generated documents. Work requires sitting for extended periods, talking on the telephone, travel to member’s homes and typing on the computer. Candidate must reside in Roanoke, Salem, Pearisburg, Narrow, New Castle, Staffordsville, Buchanan, VA or surrounding area. 2 years’ experience in behavioral health, social services or appropriate related field equivalent to program focus. Must possess reliable transportation and be willing and able to travel up to 70-75% of the time within Central Region. Mileage is reimbursed per our company expense reimbursement policy. Preferred qualifications include case management and discharge planning experience and managed care experience. Education required is Bachelor's Degree or non-licensed master level clinician with preference for behavioral health or human services degrees. Qualified Mental Health Professional License strongly preferred. LMSW, LBSW, MSW or BSW preferred.
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