Healthcare Consultant III-Field Case Management Coo

Description:
Nonclinical, must live in the state of IL; must reside in any of the following counties/coverage area:
City of Chicago Southside
Southwest Suburban Cook
Will County
Kane County
Randolph County
St. Clair County
Clinton County

Must be able to work 8am to 5pm CST time zone M-F; this is a field-based position.
Add city state county and zip code on top of resume
Field Based Case Mgmt Coordinator: Caseloads typically range from 30 to 100 members, depending on market needs and complexity of members needs.
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.
Bachelor's degree in behavioral health or human services REQUIRED (psychology, social work, marriage and family therapy, nursing, counseling, etc.) or non-licensed masters-level clinician.
The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources.

Duties:
Determines medical necessity/ appropriateness
Facilitates optimal outcomes
Identifies and follow through with continuous quality/ compliance opportunities. May also include identification of aberrances and initiation of corrective action
Educates/ empowers customers to ensure compliance, satisfaction and promote patient advocacy
Optimize total costs
Implementation and evaluation of policy based on usage and program directives
Educate/empower colleagues at all levels to enable decision making at most appropriate level

Experience:
Minimum 5 years of relevant experience

Position Summary:
Provide comprehensive healthcare management services to facilitate appropriate healthcare treatment, effectively manage healthcare costs and improve healthcare program/operational efficiency involving clinical issues

Education:
Bachelor's degree required or non-licensed master-level clinician, with degree being in behavioral health or human services (psychology, social work, marriage and family therapy, nursing, counseling, etc.)

What days & hours will the person work in this position List training hours, if different.
8am to 5pm CT Mon-Fri