Analyst, Case Management- Field

Aetna Medicaid Administrators • Fields, LA

10d • $21 - $37

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Must reside in the following Region to be considered. Region 1 = Orleans, St. Bernard, Plaquemines, and Jefferson parishes Position Summary The Case Management Coordinator (CMC) utilizes critical thinking and judgment to collaborate and inform the case management process, to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. This position is in the ABH- Louisiana Care Management Program. Schedule is Monday-Friday standard business hours 8 AM- 5 PM. No nights, no weekends, and no holidays.

Requirements

• 2+ years' experience in behavioral health, social services or appropriate related field equivalent to program focus.
• 2+ years' experience with adult and/or adolescent populations.
• Must reside in Louisiana
• Must have reliable transportation and be willing and able to travel 50% of the time or more.
• Mileage is reimbursed per company expense reimbursement policy
• Minimum of a Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (i.e., psychology, social work, marriage and family therapy.

Nice To Haves

• Medicaid experience.
• Waiver experience
• Crisis intervention skills
• Managed care/utilization review experience
• Familiarity with QuickBase
• Case management and discharge planning experience
• Demonstrated proficiency with personal computer, keyboard navigation, and mouse
• Familiarity and proficiency with MS Office Suite applications including MS Teams, Outlook, Word, Excel, and SharePoint.

Responsibilities

• Evaluation of Members: Using care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. Coordinates and implements assigned care plan activities and monitors care plan progress.
• Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes. Identifies and escalates quality of care issues through established channels. Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs. Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote 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 knowledably participate with their provider in healthcare decision-making.
• Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan .
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
• For more information, visit https://jobs.cvshealth.com/us/en/benefits

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level