***Candidates must reside near Manhattan, KS or Atchison County, KS***

Position Purpose:

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 and education for members through the use of care management tools and resources.

Responsibilities

Evaluation of Members:

- Through the use of care management tools and information/data review, conducts comprehensive

evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or

meeting 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 planning

components 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 health

programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to

obtain 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

Required Skills & Education:

• Bachelor’s degree

• 1 year(s) behavioral health, social services, or human services field.

• Willing and able to travel up to 50%-75% locally to meet members face to face in Atchison County KS and surrounding areas/counties.

• Must have reliable transportation.

Preferred Qualifications :

• - Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel is strongly preferred.

• Case management and discharge planning experience preferred

• Managed Care experience preferred

• 1-year Experience in Home and Community based services (HCBS) waiver.

#INDPM

Job Types: Full-time, Contract

Pay: $29.42 per hour

Benefits:

• Dental insurance
• Health insurance
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Location:

• Atchison County, KS (Required)

Work Location: Remote