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Arc's Assistive Technology (at) Services is seeking a Case Management Coordinator for multiple openings across Kentucky. This role focuses on case management to ensure improved healthcare outcomes for members, requiring extensive travel within the Lakes Region and flexibility in scheduling. Candidates with a background in behavioral health and experience in foster care systems are encouraged to apply.
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Position Summary
Aetna Better Health is hiring for multiple openings across the state/regions of Kentucky. Case Management Coordinator (CMC) utilizes critical thinking and professional judgment to support the case management process, in order to facilitate and maintain improved healthcare outcomes for members by providing advocacy, collaboration coordination, support and education for members through the use of care management tools and resources.
This is a telework position that requires regional in-state travel 80-90% of the time. Qualified candidate must have reliable transportation. Travel to the Louisville office for meetings and training is also anticipated. This position is assigned to the LAKES Region (Fulton, Hickman, Carlisle, Ballard, Graves, McCracken, Calloway, Marshall, Livingston, Lyon, Trigg, Crittenden, Caldwell, Hopkins, Christian, Muhlenberg, Todd ).
Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm CST, is required. We are serving the needs of children and families that may require working after school, after work, etc.
Evaluation of Members:
- Through the use of care management assessments and information/data review, recommends an approach to resolving care needs maintaining optimal health and well-being 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 implements early and proactive support interventions.
- Coordinates and implements Wellness care plan activities and monitors member care needs.
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 benefits and/or healthcare needs.
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Helps member actively and knowledgably participate with their provider in healthcare decision-making.
Monitoring, Evaluation and Documentation of Care:
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Required Qualifications