The Case Manager is responsible to coordinate clinically complex patient’s care across a continuum; ensuring and facilitating the achievement of quality clinical and cost outcomes, negotiating, procuring and coordinating appropriate services and resources needed by the patients, and at key points, intervening to address and resolve issues/concerns. Key in ensuring appropriate sequencing of treatment goals and implementation of a comprehensive discharge plan. Demonstrate knowledge and skills necessary to provide case management services to the patient population experiencing rehabilitation needs.

The Clinical Liaison is clinical leader in the Medicaid plan focusing on integrating member care, clinical coordination, leading the development, implementation and ongoing monitoring of program and quality initiatives to address the needs of Aetna members. They represent the plan and collaborate with State governments, key stakeholders, community organizations, advocacy groups as well as the Medicaid Plan’s Chief Medical Officer and leadership team to enhance the quality of services provided to Aetna members and to ensure adherence to performance targets of the business area.Monday - Friday standard business hours.No nights, no weekends and no holidays!Partners with Plan executive leadership team to provide overall vision and leadership across all Plan activities. Serves as a key resource regarding any issues related to the integration of member care across departments. Consults with Plan executive management regarding physical and behavioral health clinical issues as they relate to medical management (UM, CM, DM) provider and system of care issues, behavioral health and human services system issues including critical stakeholders such as various departments of state government, provider organizations, advocacy organizations, etc. Partners with Aetna Medicaid’s regional psychiatrist(s) to manage and oversee ICM within the health plan. Provides consultation to support physicians at other Medicaid Plans. Participates in organizational planning, including strategic plans, business plans, and new product development. Elicits staff input related to their job functions and leverages errors and failure to reach performance targets as opportunities for organizational learning and improvement. Supports and encourages CM, UM and DM staff to function as interdisciplinary team, with requisite range and depth of subject matter expertise to meet the needs of the covered population. Represents Plan to relevant external stakeholders, such as state government officials, provid

This position will be working from home and will require the employee to make community visits once COVID restrictions are lifted. Travel will be in one of the following counties: Lake and PorterWorking for a dynamic, industry leading health care company that puts the focus on the member is what CVS-Aetna is all about. If you like working independently as a Social Worker and as part of a Team, this position may be what you have been looking for. As our company continues to grow our stake hold in local communities is what makes our company stand out in the health care industry. Our talented and caring health care professionals drive the delivery of high-quality services.

This position will be working from home, and will require travel once COVID restrictions have been lifted. Travel will be within one the following counties: Catawba, Iredell, Mecklenburg, Gaston, Cabarrus, Union, or LincolnUtilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

This position will be working from home and will require the employee to make community visits once COVID restrictions are lifted. Travel will be in one of the following cities: St. Louis, Jefferson, Franklin, Kansas City, or St. Charles.Working for a dynamic, industry leading health care company that puts the focus on the member is what CVS-Aetna is all about. If you like working independently as a Social Worker and as part of a Team, this position may be what you have been looking for. As our company continues to grow our stake hold in local communities is what makes our company stand out in the health care industry. Our talented and caring health care professionals drive the delivery of high-quality services.

This position will be working from home, but will require the employee to live in Queens or Nassau County as there will be local travel once COVID restrictions are liftedUtilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.Schedule is Monday-Friday standard business hours. No nights, no weekends and no holidays.Manage territory within region they reside in West Virginia.

As a TeamHealth clinician, you will receive support services, networks of communication, educational resources and access to join a community of thousands of professionals to share and shape best practices. We harness a nationwide collection of tools, clinical resources and collective knowledge for our clinicians who provide the best for their patients.

The Clinical Case Manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.This position requires the ability to travel up to 50% of the time with use of a personal vehicle. Must have active KY driver’s license, proof of vehicle insurance, and reliable transportation. Routine and frequent visitation to assigned hospitals in the region is required. Travel to the Louisville office is also anticipated for meetings and training.This position is assigned to the Eastern Mountain region (Breathitt, Floyd, Johnson, Knott, Lee, Leslie, Letcher, Magoffin, Martin, Owsley, Perry, Pike, and Wolfe counties). Qualified candidates may reside in or adjacent to the assigned region.

Job DescriptionUtilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.This position requires the ability to travel up to 50% of the time with use of a personal vehicle. Must have active KY driver’s license, proof of vehicle insurance, and reliable transportation. Routine and frequent visitation to assigned hospitals in the region is required. Travel to the Louisville office is also anticipated for meetings and training.This position is assigned to the Northeastern region (Bath, Boyd, Bracken, Carter, Elliott, Fleming, Greenup, Lawrence, Lewis, Mason, Menifee, Montgomery, Morgan, Robertson, and Rowan counties). Qualified candidates may reside in or adjacent to the assigned region. At Aetna Better Health of Kentucky, we reach beyond ensuring access to quality health care by focusing on resilient healing for children and their families. Our vision is to construct local, regional, and state-level coalitions to create a shared, in-common vision of health promoting and resiliency building approaches, to engage and support children to have membership in a family and community, while services and permanency planning are occurring. By keeping families safely together, children in Kentucky SKY will experience less trauma, which leads to better outcomes. To accomplish this, we are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to supporting children, young people, parents, and other important partners involved with child protection systems. We value diversity and are dedicated to helping you achieve your career goals.