Job Description This position will be working from home and will require frequent travel within Baltimore, Baltimore City, Anne Arundel and/or Maryland
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services across the Enterprise. Social Workers play an integral role on the Interdisciplinary Team to work with Members to reach their health care goals. CVS-Aetna has a competitive edge in the health care industry and strive to continue to evolve as consumer obsessed teams collectively work on driving members goals of a healthier quality of life. Utilizes advanced clinical judgment and critical thinking skills to facilitate timely and appropriate assessment of the member as it relates to, behavioral health care and other needs as indicated by assessment and care planning. Coordinates direct provider coordination/collaboration and assesses psychosocial needs to promote effective utilization of available resources and optimal, cost-effective outcomes. The Field Care Manager uses a collaborative process of working on an Interdisciplinary Team across all lines of business, including, Medicare, and Commercial plans. The Field Care Manager works with the Members by assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individualâ™s and familyâ™s comprehensive health needs
Assessment of Members: Through the use of clinical tools and information/data review, in members record and other sources, conducts comprehensive assessments of referred memberâ™s needs/eligibility & determines approach to case resolution and/or meeting needs by evaluating memberâ™s benefit plan and available internal and external programs/services. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues. -Performs job related functions by providing Field Work to Members by doing face to face visits, and in-home assessment on members overall functional status related to Social Determinants of Health that may hinder them from meeting their health care goals. Utilizes all established work platforms required while conducting face to face visits with the Member These platforms are, but not limited to Salesforce, Med-Compass, ATV, and others as assigned. All documentation on members care plans completed in the assigned systems as listed. Performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment & treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
Quality of Care and Services: Ensures quality of services that are in direct alignment with Medicare criteria and follows NCQM guidelines on all applicable criteria and clinical guidelines that include standardized case management plans, policies, procedures, & regulatory standards while assessing benefits and/or memberâ™s needs to ensure appropriate administration of benefits - Using holistic approach consults with Supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes - Identifies and escalates quality of care issues through established channels -Ability to speak to medical and behavioral health professionals to influence appropriate member care. - Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes 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 -Analyzes all utilization, self-report, and clinical data available to consolidate information and begin to identify comprehensive member needs.
Monitoring, Evaluation and Documentation of Care: -In collaboration with the member and their care team develops and monitors established plans of care to meet the memberâ™s goals -Utilizes case management & quality management processes in compliance with regulatory and accreditation guidelines & company policies & procedures.
Required Qualifications LCSW: (LCSW or state equivalent â“ LISW or LISW-S in Ohio) 3-5 years of direct clinical practice experience post masterâ™s degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
- Knowledge of laws and regulations governing delivery of Medicare services. - CCM Certification is a plus. - Must exercise independent and sound judgment in decision making. - Must be highly organized to manage continuously changing priorities. - Proficiency with computers â“ (MS Outlook, Excel, PowerPoint, and Word) and must navigate multiple systems simultaneously
Preferred Qualifications Case management and discharge planning experience preferred Managed care/utilization review experience preferred - Crisis intervention skills preferred
Education Master's Degree
Business Overview At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.
Internal Number: 1692179BR
About CVS Health
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.
At CVS Health, we work every day to help people on their path to better health. Never has it been more important for us to deliver on our purpose to our valued customers, patients, members, and employees. With a presence in communities across the country, CVS Health colleagues are and will continue to be a critical piece of the country’s health care solution. The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together. If you would like to learn about the actions we are taking as a company as we learn more about COVID-19 and its spread, we encourage you to visit our COVID-19 resource center at https://cvshealth.com/covid-19
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to... attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. 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. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. Please note that we only accept applications for employment via this site.
We provide reasonable accommodations to qualified individuals with disabilities. If you need to request an accommodation, a qualified interpreter, written information in other formats, translation or other services, please contact our Advice and Counsel Reasonable Accommodations team by emailing Advice and Counsel Reasonable Accommodations team or calling 877-805-9511.
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