Case Manager ) Work From Home Richmond, Insurance @ Tod

Overview

Job Title:

Case Manager
Salary: $20-30/Hour
Company:
Aetna

Location:

Richmond, USA

Educational Requirements:

Bachelor's Degree
No nights, no weekends, and no holidays

• Utilizes superior scientific judgment and vital thinking abilties to facilitate suitable member physical health and behavioral healthcare via evaluation and care making plans, direct company coordination/collaboration, and coordination of psychosocial wraparound offerings to sell effective usage of to be had resources and premier, price-effective results.
• Assessment of participants:
  Through using scientific gear and facts/statistics evaluation, conducts complete assessments of referred member’s wishes/eligibility and determines method to case resolution and/or assembly desires through comparing member’s advantage plan and available internal and external programs/services.
• Applies scientific judgment to the incorporation of techniques designed to lessen chance elements and address complicated medical signs which impact care planning and determination of member troubles.
• The usage of advanced medical skills, plays disaster intervention with individuals experiencing a behavioral health or scientific crisis and refers them to the perfect medical carriers for thorough evaluation and remedy, as clinically indicated.
• Provides disaster follow as much as participants to help ensure they may be receiving the suitable remedy/offerings.

• Application and/or interpretation of relevant standards and scientific recommendations, standardized case management plans, regulations, procedures, and regulatory requirements whilst assessing benefits and/or member’s desires to make sure appropriate management of blessings
• The usage of holistic technique consults with supervisors, clinical administrators and/or other applications to triumph over limitations to meeting goals and targets; gives cases at case conferences to acquire multidisciplinary view in an effort to gain superior results
• Identifies and escalates quality of care problems thru mounted channels
• Potential to talk to medical and behavioral fitness specialists to steer suitable member care.
• Utilizes influencing/motivational interviewing abilities to make sure maximum member engagement and promotes life-style/conduct adjustments to reap greatest level of health
• Provides training, records and aid to empower the member to make ongoing independent scientific and/or healthful lifestyle alternatives.
• Facilitates member actively and knowledgably take part with their issuer in healthcare selection-making
• Analyzes all usage, self-report and clinical facts available to consolidate records and begin to identify comprehensive member needs.

• In collaboration with the member and their care team develops and video display units mounted plans of care to meet the member’s desires
• Utilizes case control and high-quality control strategies in compliance with regulatory and accreditation suggestions and organisation regulations and techniques.