This position will be working from home and will require home visits post COVID. Employee must be located and licensed in Nevada.
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.
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
Additional Job Information
Knowledge of the regulations, standards, and policies which relate to social work practice.Knowledge of individual and group behavior and inter-relationships among social, economic psychological and physical factors.Extensive knowledge of community resources.Thorough knowledge of casework and group work principles, practices, and methodology.
Percent of Travel Required
10 - 25%
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.