Case Management Coordinator - Bilingual (French Creole)

Case Management Coordinator - Bilingual (French Creole)

Aetna Inc. | New York, NY, 10007, US
Salary Range:$52,000 – $73,000 Salary range estimated by Zippia

Posted 11 days ago

Apply Now

Description

Job Description

Work at home in the continental U.S. Preference to reside in New York or surrounding states.

Required schedule: Monday-Friday 8:30am-5:00pm EST.

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.

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 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.

Pay Range

The typical pay range for this role is:

Minimum: 19.50

Maximum: 40.10

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

* Bilingual in French Creole required
* 2+ years of experience healthcare field

Preferred Qualifications

* Experience in Managed care (MLTC, MAP, FIDE, PACE)
* Excellent computer skills - Microsoft Word, Microsoft Excel, Microsoft Outlook
* Masters in Social Work
* 2+ years of case management
* Experience with the Medicaid population

Education

Bachelors Degree in social services field required

Masters in Social Services preferred

Business Overview

Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.