**Experienced Case Management Specialist - Remote Customer Service Opportunity with Aetna (Full-time, Work from Home)**

Join Aetna's Mission to Transform Healthcare and Make a Difference in the Lives of Individuals with Complex Needs

At Aetna, we're dedicated to revolutionizing the healthcare industry by providing top-notch care and support to individuals with diverse needs. As a leader in serving dual-eligible populations, we're seeking a compassionate and skilled Case Management Specialist to join our team remotely. This full-time opportunity offers a chance to make a meaningful impact on the lives of individuals enrolled in our Dual Special Needs Plan (DSNP), who face a range of complex health and social challenges.

About Aetna and Our Culture

Aetna is a renowned healthcare company committed to delivering exceptional patient care and customer service. Our mission is to improve the health and well-being of individuals and communities by providing innovative solutions, education, and support. We value diversity, empathy, and collaboration, and we're looking for team members who share our passion for making a difference.

Job Summary and Mission

As a Case Management Specialist, you will play a vital role in our team by using your expertise and judgment to facilitate the case management process. You will work closely with individuals, healthcare providers, and community organizations to address the full continuum of their healthcare and social determinant needs. Your primary goal will be to ensure that individuals receive comprehensive and coordinated care, leading to improved health outcomes and enhanced quality of life.

Key Responsibilities

* **Assessment of Individuals**: Conduct thorough assessments of individuals' needs and qualifications using care management tools and data. Develop and implement personalized care plans to address their unique needs and goals. * **Care Planning and Coordination**: Collaborate with healthcare providers, case managers, and other stakeholders to develop and implement effective care plans. Identify high-risk factors and service needs, and make referrals to clinical case management or emergency intervention as needed. * **Clinical Utilization and Quality of Care**: Work with case managers, Clinical Chiefs, and other healthcare professionals to overcome barriers to meeting goals and objectives. Present cases at case conferences to ensure multidisciplinary review and optimal outcomes. * **Patient Education and Empowerment**: Provide coaching, information, and support to enable individuals to make informed decisions about their healthcare and lifestyle choices. Facilitate navigation of the healthcare system and promote self-advocacy. * **Monitoring, Evaluation, and Documentation**: Use case management and quality management processes to monitor and evaluate the effectiveness of care plans. Document individual progress and outcomes in accordance with regulatory requirements and company policies.

Essential Qualifications

* **Education**: Bachelor's degree or equivalent experience required * **Experience**: 3+ years of experience in a health-related field * **Skills**: Strong communication, interpersonal, and problem-solving skills * **Certifications**: Preferred certifications include CRC, CDMS, CRRN, COHN, or CCM

Preferred Qualifications

* **Certifications**: CRC, CDMS, CRRN, COHN, or CCM certification * **Experience**: Federal health insurance and Medicaid experience; managed care experience; experience working with geriatric special needs, social health, and disabled populations * **Language**: Bilingual (English/Spanish; English/Creole) * **Knowledge**: Knowledge of evaluation, screenings, and care planning

What We Offer

* **Competitive Compensation**: The regular compensation range for this job is $19.52 - $40.90 per hour, depending on experience and qualifications * **Comprehensive Benefits**: A full range of clinical, dental, and vision benefits; 401(k) retirement savings plan; Employee Stock Purchase Plan; term life insurance; short-term and long-term disability benefits * **Professional Development**: Training and education assistance; free development courses; opportunities for career growth and advancement * **Work-Life Balance**: Paid time off (PTO); paid holidays; flexible work arrangements

Why Join Aetna?

* **Make a Difference**: Join a team that's dedicated to transforming healthcare and making a positive impact on the lives of individuals with complex needs * **Professional Growth**: Develop your skills and expertise in a dynamic and supportive environment * **Flexibility**: Work from home and enjoy a flexible work schedule * **Comprehensive Benefits**: Enjoy a comprehensive benefits package that supports your health and well-being

How to Apply

If you're passionate about delivering exceptional patient care and customer service, we encourage you to apply for this exciting opportunity. Please submit your application through our website: Apply Job! For more job opportunities, please visit: Browse Jobs Apply for this job