Remote + of 'Healthcare Consultant III - Case Management Coordinator

Position: 25% Remote + 75% Travel Job Role of 'Healthcare Consultant III - Case Management Coordinator’ i[...] Job Title: Healthcare Consultant III - Case Management Coordinator Job : 26-05639 Estimated Length of Assignment: 3+ months with possible extension (the dates provided are only an estimate and not a guarantee) Estimated Pay: $23.00 – $27.70 per hour on W2 (USD) – all inclusive Work Type: 25% remote + 75% travel counties – DuPage, Will, Winnebago, Kane, Rock Island in IL Schedule: Monday‑Friday, 8am‑5pm CST Location requirement: Must live in IL in one of the counties: DuPage, Will, Winnebago, Kane, Rock Island. Must be available M‑F 8am‑5pm CST.

Overview

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best‑in‑class operating and clinical models. You can have life‑changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

Qualifications

• Bachelor’s degree in behavioral health or human services (psychology, social work, marriage and family therapy, nursing, counseling, etc.) or non‑licensed masters‑level clinician.
• Case management and discharge planning experience preferred.
• 2 years’ experience in behavioral health, social services or related field.
• Managed Care experience preferred.
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually.
• Excellent analytical and problem‑solving skills.
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently.
• Proficiency with MS Word, Excel, Outlook, PowerPoint, and proprietary applications.
• Efficient computer skills including navigating multiple systems and keyboarding.

Duties

• Utilize critical thinking and judgment to collaborate and inform the case management process; facilitate appropriate healthcare outcomes by providing assistance with appointment scheduling, accessing benefits, and member education through care management tools and resources.
• Conduct comprehensive evaluation of members’ needs and eligibility using care management tools and data review; recommend an approach to case resolution and assess benefit plans and available programs.
• Identify high‑risk factors and service needs that may impact member outcomes; refer to clinical case management or crisis intervention as appropriate.
• Coordinate and implement assigned care plan activities; monitor progress.
• Enhance medical appropriateness and quality of care by consulting with case managers, supervisors, medical directors or other health programs; present cases at conferences for multidisciplinary review.
• Identify and escalates quality of care issues through established channels.
• Use negotiation skills to secure appropriate options and services necessary to meet member benefits and healthcare needs.
• Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes.
• Provide coaching, information, and support to empower the member to make ongoing independent medical and healthy lifestyle choices.
• Engage with colleagues in ongoing team meetings and offer peer mentoring/training.
• Help member actively and knowledgeably participate with their provider in healthcare decision‑making.
• Maintain monitoring, evaluation, and documentation of care using case management and quality management processes in compliance with regulations and company policies.

Experience and Background Highlights Experience required or preferred as outlined in the Qualifications section. #J-18808-Ljbffr Apply tot his job Apply To this Job