Case Management Analyst - Field in Northern VA

CVS Health•Field-Virginia, VA

1d•$21 - $41•Onsite

About The Position

This Analyst, Case Management position is with Aetna’s Long-Term Services and Supports (LTSS) team and is a field-based position out of Annandale / Springfield / Falls Church / Arlington. The requirements is for candidates to travel 75% of the time to meet with members face to face. Case Manager Analyst is responsible for face to face and telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Develops a proactive course of action to address issues presented to enhance the short and long- term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies. Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. Productivity and quality expectations. Work requires the ability to perform close inspection of handwritten and computer-generated documents. Work requires sitting for extended periods, talking on the telephone, travel to member’s homes and typing on the computer.

Requirements

Candidate must reside in Annandale / Springfield / Falls Church / Arlington or surrounding areas.
2 years’ experience in behavioral health, social services or appropriate related field equivalent to program focus
Must possess reliable transportation and be willing and able to travel up to 75% of the time within Central Region.
Ability to perform close inspection of handwritten and computer-generated documents.
Ability to sit for extended periods, talk on the telephone, travel to member’s homes and type on the computer.

Nice To Haves

Case management and discharge planning experience
Managed care experience
Qualified Mental Health Professional License strongly preferred
LMSW, LBSW, MSW or BSW preferred

Responsibilities

Face to face and telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
Develops a proactive course of action to address issues presented to enhance the short and long- term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
Conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
Reviews prior claims to address potential impact on current case management and eligibility.
Assess the need for a referral to clinical resources for assistance in determining functionality.
Consults with supervisor and others in overcoming barriers in meeting goals and objectives.
Presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
Utilizes case management processes in compliance with regulatory and company policies and procedures.
Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.