Case Management Analyst - Field in Will and DuPage Counties, IL - New Hire Bonus Available

CVS Health • Field Township, IL

1d • $21 - $45 • Hybrid

About The Position

The Case Management Analyst is a field-based role on Aetna’s Long-Term Services & Supports (LTSS) team, serving waiver members in Will and DuPage Counties and the west side of the Chicago area. The position carries a full caseload and requires travel 50–75% of the time to meet members face to face, including in-person quarterly visits. The role is critical to meeting contractual requirements and facilitates appropriate healthcare outcomes by providing care coordination, support, and education through care management tools and resources.

The analyst evaluates referred members’ needs and eligibility, reviews benefit plans and available programs and services, identifies high-risk factors and service needs, coordinates care-plan activities, and monitors progress. The role works with case managers, supervisors, Medical Directors, and other health programs to address barriers, presents cases for multidisciplinary review, escalates quality-of-care issues, and negotiates appropriate services. It also promotes member engagement and informed healthcare decisions through coaching, motivational interviewing, information, and support. Case management and quality management processes must be followed in compliance with regulatory and accreditation guidelines and company policies.

This position includes work-from-home requirements for a quiet, secure, private, HIPAA-compliant work location with a hardwired internet connection meeting the stated speed requirements. The company provides computer equipment, while the employee supplies workspace furniture. The role requires comfort using multiple monitors and applications, digital communication and collaboration tools, secure systems, and basic troubleshooting.

Requirements

• Must reside in Illinois in the west side of the Chicago area.
• Valid Illinois driver’s license.
• Reliable transportation and willingness and ability to travel up to 75% of the time; mileage is reimbursed under the company expense reimbursement policy.
• At least two years of case management experience.
• Experience with Microsoft Office and electronic health records.
• Bachelor’s degree in a human-services field, or a master’s degree in a human-services field for a non-licensed individual.
• Must have or be able to obtain a direct, hardwired internet connection to a modem or router within seven feet of the computer, with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
• Must maintain a quiet, secure, private, tidy, and organized designated home work location compliant with CVS Health and HIPAA guidelines, and work within the state and city where currently living.
• Must provide workspace furniture, such as a desk or standing desk, and commit to meeting work-from-home requirements.
• Ability to set up and use multiple monitors and navigate multiple applications simultaneously.
• Ability to use digital communication tools such as email, calendar invites, Teams messaging, and virtual meetings.
• Ability to use Microsoft Office 365 applications or similar tools such as Google Workspace.
• Ability to access secure systems, follow computer and password security practices, and recognize suspicious emails or links.
• Ability to resolve common technical issues independently and contact IT for unresolved issues.
• Openness to learning new skills as the workplace evolves.

Nice To Haves

• Case management and discharge planning experience.
• Managed care experience.
• Microsoft Office experience.
• Experience working with the HIV and AIDS population.
• Multilingual language proficiency.

Responsibilities

• Evaluate referred members’ needs and eligibility using care management tools and information and data review.
• Recommend approaches to resolve cases and meet member needs by evaluating 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, and make appropriate referrals to clinical case management or crisis intervention.
• 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 appropriate options and services to meet 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 empower members to make independent medical and healthy lifestyle choices.
• Help members participate actively and knowledgeably in healthcare decisions with their providers.
• Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Conduct in-person quarterly visits with members and travel to meet members face to face.

Benefits

• Medical coverage.
• Dental coverage.
• Vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources supporting physical, emotional, and financial well-being, based on eligibility.
• Eligibility for a CVS Health bonus, commission, or short-term incentive program.
• Mileage reimbursement under the company expense reimbursement policy.

What This Job Offers

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