Are you passionate about improving the lives of individuals with complex health needs? Do you have experience in developing and implementing care plans? Aetna is seeking a Care Plan Reviewer for our OhioRISE team to support the delivery of high-quality, person-centered care for our members. As a Care Plan Reviewer, you will play a critical role in evaluating and updating care plans for individuals with behavioral health and developmental disabilities. We are looking for a highly organized and compassionate individual with a background in healthcare or social services. Join us in making a positive impact on the lives of our members while advancing your career with a leading healthcare company.
- Evaluate and update care plans for individuals with complex health needs, including behavioral health and developmental disabilities.
- Collaborate with healthcare providers and other members of the OhioRISE team to ensure the delivery of person-centered care.
- Utilize knowledge and experience in developing and implementing care plans to improve the lives of individuals.
- Conduct thorough assessments of members' health needs and make recommendations for care plan revisions.
- Maintain accurate and detailed documentation of care plan reviews and updates.
- Communicate effectively with members, caregivers, and healthcare professionals to ensure understanding and compliance with care plans.
- Advocate for the needs and preferences of members to promote their overall well-being.
- Continuously monitor and evaluate the effectiveness of care plans and make necessary adjustments.
- Stay up-to-date on industry standards and best practices for care plan development and implementation.
- Use critical thinking and problem-solving skills to address complex health needs and ensure the best possible outcomes for members.
- Participate in team meetings and collaborate with other departments to ensure high-quality care for members.
- Demonstrate empathy, compassion, and cultural sensitivity in all interactions with members and their families.
- Adhere to company policies and regulatory requirements in all aspects of the job.
- Support the mission and values of the company while promoting a positive work environment.
- Continuously strive for personal and professional growth and development in the healthcare field.
Bachelor's Degree In Nursing, Social Work, Or A Related Field.
Minimum Of 3 Years Of Clinical Experience In A Healthcare Setting, Preferably With Experience In Care Management Or Care Coordination.
Knowledge Of Ohio's Medicaid Programs, Including Ohiorise.
Strong Understanding Of Care Management Principles And The Ability To Effectively Review And Evaluate Care Plans.
Excellent Communication And Interpersonal Skills, With The Ability To Collaborate With A Multidisciplinary Team And Provide Constructive Feedback To Care Providers.
Communication Skills
Analytical skills
Attention to detail
Critical thinking skills
Problem-solving skills
Time Management Skills
Organization Skills
Assessment skills
Decision-Making Skills
Collaborative Skills
Communication
Conflict Resolution
Emotional Intelligence
Leadership
Time management
Interpersonal Skills
Critical thinking
Teamwork
Adaptability
Problem-Solving
According to JobzMall, the average salary range for a Care Plan Reviewer - OhioRISE in Ohio, USA is $60,000 - $80,000 per year. This range can vary depending on factors such as experience, education, and location. Some employers may also offer additional benefits such as bonuses or healthcare benefits.
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Aetna Inc. is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare. Since November 28, 2018, the company has been a subsidiary of CVS Health.

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