Case Management Analyst - Field in Roanoke Virginia

CVS Health•Roanoke, VA

2d•Onsite

About The Position

This Analyst, Case Management position is with Aetna’s Long-Term Services and Supports (LTSS) team and is field-based in the Roanoke, Virginia region. The role requires travel up to 75% of the time to meet with members face to face. The analyst collaborates in the case management process to support appropriate healthcare outcomes through care coordination, education, and use of care management tools and resources. The position evaluates members’ needs and eligibility, considers benefit plans and available services, identifies risk factors and service needs, and recommends approaches to case resolution. The analyst coordinates and monitors care plan activities, works with case managers and other professionals to address barriers, escalates quality-of-care issues, and helps members access appropriate services and participate in healthcare decisions. The role applies case management and quality management processes in accordance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

At least 2 years of experience in behavioral health, social services, or an appropriate related field equivalent to the program focus.
Must reside in Roanoke, Virginia, or surrounding areas.
Must have reliable transportation and be willing and able to travel up to 75% of the time.
Bachelor’s degree or non-licensed master-level clinician required.

Nice To Haves

Case management and discharge planning experience.
Managed care experience.
LTSS experience.
A degree in behavioral health or human services, such as psychology, social work, marriage and family therapy, or counseling.
Certification in LMHP, QMHP, LMSW, LBSW, MSW, or BSW.

Responsibilities

Collaborate in the case management process to facilitate appropriate healthcare outcomes through care coordination, support, and member education.
Use care management tools and information to evaluate members and conduct comprehensive assessments of their needs and eligibility.
Recommend approaches to case resolution and meeting member needs by evaluating benefit plans and available internal and external programs and services.
Identify risk factors and service needs that may affect member outcomes and care planning, and refer members to clinical case management or crisis intervention when appropriate.
Coordinate assigned care plan activities and monitor care plan 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 to support optimal outcomes.
Identify and escalate quality-of-care issues through established channels.
Use negotiation skills to secure appropriate options and services for members’ benefits and healthcare needs.
Use motivational interviewing to encourage 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 knowledgeably with their providers in healthcare decision-making.
Apply case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Travel to meet members face to face, up to 75% of the time.