Analyst, Case Management
About The Position
This field-based Analyst, Case Management position is part of Aetna’s Long Term Services & Supports (LTSS) team and serves members in the Macon County area of Illinois. The role requires travel 50–75% of the time for face-to-face member visits and management of a full caseload of waiver members. In-person quarterly member visits are required to meet contractual requirements. The analyst facilitates appropriate health outcomes for waiver/LTSS members by providing care coordination, support, and education using care management tools and resources. The analyst evaluates referred members’ needs and eligibility, reviews available information and benefits, identifies risks and service needs, recommends approaches to resolve cases, and coordinates care plan activities. The role works with case managers, supervisors, Medical Directors, and other health programs to address barriers and improve quality of care. It also supports member engagement and informed decision-making through negotiation, motivational interviewing, coaching, information, and support. Care is monitored, evaluated, and documented in accordance with regulatory and accreditation guidelines and company policies and procedures.
Requirements
- Must reside in the Macon County area of Illinois.
- Valid Illinois driver’s license.
- Willingness and ability to travel up to 75% of the time for face-to-face member visits.
- Reliable transportation; eligible for mileage reimbursement under company policy.
- At least two years of case management experience.
- Microsoft Office and electronic health record experience.
- Bachelor’s degree in a human-services field, or a master’s degree in a human-services field for a non-licensed individual. Examples include sociology, special education, and rehabilitation counseling.
Nice To Haves
- Case management and discharge planning experience.
- Managed Care experience.
- Microsoft Office experience.
Responsibilities
- Evaluate referred members’ needs and eligibility using care management tools and information review.
- Recommend approaches to case resolution and meeting member needs by reviewing benefit plans and available internal and external programs and services.
- Identify high-risk factors and service needs that may affect member outcomes and care planning; refer members to clinical case management or crisis intervention when appropriate.
- Coordinate and implement assigned care plan activities and monitor progress.
- Consult with case managers, supervisors, Medical Directors, and other health programs to address barriers to goals and objectives.
- Present cases at case conferences for multidisciplinary review and optimal outcomes.
- Identify and escalate quality-of-care issues through established channels.
- Negotiate to secure appropriate options and services for members’ benefit and healthcare needs.
- Use influencing and motivational interviewing skills to support member engagement and lifestyle or behavior changes.
- Provide coaching, information, and support to help members make independent medical and healthy lifestyle choices.
- Help members participate actively and knowledgeably in healthcare decisions with their providers.
- Apply case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
- Conduct required in-person quarterly visits with members and manage a full caseload of waiver members.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
- Eligible for a CVS Health bonus, commission, or short-term incentive program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
