This position will be working from home and will require home visits post COVID. Employee must be located and licensed in West Virginia. Home visits will require the candidate to be within a commutable distance to one of the following counties: Barbour, Boone, Braxton, Brooke, Cabell, Calhoun, Clay, Doddridge, Fayette, Gilmer, Greenbrier, Hancock, Harrison, Jackson, Kanawha, Lewis, Lincoln, Marion, Marshall, Mason, Monongalia, Nicholas, Ohio, Pleasants, Preston, Putnam, Raleigh, Ritchie, Roane, Summers, Taylor, Tyler, Upshur, Wayne, Wetzel, Wirt, Wood
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 Dual Eligible Special Needs Plan (DSNP) 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 DSNP to change lives in new markets across the country.
The Social Worker participates in the care planning process in collaboration with the Care Manager, to include the following actions: assessment, goal setting, establishing interventions related to goals, identifying barriers and strategies to address, monitoring success of the interventions, evaluating the success of the overall care plan and reporting outcomes.
Aetna is an Equal Opportunity, Affirmative Action Employer
Fundamental Components Fundamental Components
- Care management activities will focus on quality of care, compliance, outcomes and decreasing costs.
- Responsible for developing and carrying out strategies to coordinate and integrate post-acute and long-term care services to members to prevent exacerbations and/or placement of the members in custodial care.
- Performs initial and periodic assessments of the members enrolled in the Long-Term Care Program and/or care programs.
- Applies social work concepts, principles, and strategies in addressing the social determinants of health needs in members individualized care plan.
- Conducts regular discussion and updates with providers, primary care physicians, Medical Directors, pharmacists, and care management staff regarding the status of members and progress towards goals.
- Serves as a member advocate to ensure the member receives all the necessary care allowed under the member's benefit plan and as available through Medicaid benefits and/or other community resources.
- Develops relationships with hospital social workers and community resources and utilizes available data to assure appropriate care management of catastrophic, acute, and chronically ill members with the goal of appropriate utilization, decreased length of stay, and preventable emergency room utilization.
- Assists in the identification and reporting of potential quality improvement issues.
- Directs social work interventions including performing psychosocial assessment of the populations, telephone follow up and in-home or facility assessments as indicated, documentation of problems, assessments, and/or interventions, and promoting ease of access to a continuum of care through appropriate information and referral.
- Minimum of 2 years' experience in medical social work or case management.
- Complies with all state requirements in the state where job duties are performed.
- Ability to travel locally as required.
Education and Certification Requirements
- Master's degree must be in Social Work
- License in social work required
Benefit eligibility may vary by position.
Candidate Privacy Information
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.