Job Responsibilities: Case Manager
Salary: $20-30/Hour
Company: Aetna
Location: Richmond, USA
Educational Requirements: Bachelor's Degree
No nights, no weekends, and no holidays
Utilizes superior scientific judgment and vital thinking abilties to facilitate suitable member physical health and behavioral healthcare via evaluation and care making plans, direct company coordination/collaboration, and coordination of psychosocial wraparound offerings to sell effective usage of to be had resources and premier, price-effective results.
Assessment of participants:
- Through using scientific gear and facts/statistics evaluation, conducts complete assessments of referred member’s wishes/eligibility and determines method to case resolution and/or assembly desires through comparing member’s advantage plan and available internal and external programs/services.
- Applies scientific judgment to the incorporation of techniques designed to lessen chance elements and address complicated medical signs which impact care planning and determination of member troubles.
- The usage of advanced medical skills, plays disaster intervention with individuals experiencing a behavioral health or scientific crisis and refers them to the perfect medical carriers for thorough evaluation and remedy, as clinically indicated.
- Provides disaster follow as much as participants to help ensure they may be receiving the suitable remedy/offerings.
Enhancement of clinical Appropriateness and best of Care:
- Application and/or interpretation of relevant standards and scientific recommendations, standardized case management plans, regulations, procedures, and regulatory requirements whilst assessing benefits and/or member’s desires to make sure appropriate management of blessings
- The usage of holistic technique consults with supervisors, clinical administrators and/or other applications to triumph over limitations to meeting goals and targets; gives cases at case conferences to acquire multidisciplinary view in an effort to gain superior results
- Identifies and escalates quality of care problems thru mounted channels
- Potential to talk to medical and behavioral fitness specialists to steer suitable member care.
Utilizes influencing/motivational interviewing abilities to make sure maximum member engagement and promotes life-style/conduct adjustments to reap greatest level of health
- Provides training, records and aid to empower the member to make ongoing independent scientific and/or healthful lifestyle alternatives.
- Facilitates member actively and knowledgably take part with their issuer in healthcare selection-making
- Analyzes all usage, self-report and clinical facts available to consolidate records and begin to identify comprehensive member needs.
Tracking, assessment and Documentation of Care
- In collaboration with the member and their care team develops and video display units mounted plans of care to meet the member’s desires
- Utilizes case control and high-quality control strategies in compliance with regulatory and accreditation suggestions and organisation regulations and techniques.
