Case Management Analyst – Field in Macon County Illinois

CVS Health•Field Township, IL

1d•$21 - $45

About The Position

This field-based position is with Aetna’s Long-Term Services and Supports (LTSS) team and is based in Macon County, Illinois. The role requires travel 50–75% of the time to meet with members face to face in Macon County and surrounding areas. The Case Management Coordinator facilitates appropriate healthcare outcomes by providing members with care coordination, support, and education through care management tools and resources. The position evaluates referred members’ needs and eligibility, recommends approaches to address needs, identifies high-risk factors, coordinates and monitors care plan activities, and makes referrals to clinical case management or crisis intervention when appropriate. The coordinator works with case managers, supervisors, Medical Directors, and other health programs to address barriers and achieve care goals. The role also supports member engagement and informed healthcare decisions through coaching, negotiation, and motivational interviewing, and uses case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies.

Requirements

At least 2 years of experience in behavioral health, social services, or a human services field.
At least 2 years of case management experience.
Must reside in Macon County, Illinois.
Must have reliable transportation and be willing and able to travel up to 50–75% of the time to meet members face to face in Macon County and surrounding areas.
Active driver’s license, preferably issued in Illinois.
Bachelor’s degree or non-licensed master-level clinician credential in behavioral health or human services, such as psychology, social work, marriage and family therapy, or 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 or data review.
Recommend approaches to resolve cases or 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.
Refer members to clinical case management or crisis intervention when appropriate.
Coordinate and implement assigned care plan activities and monitor care plan progress.
Consult with case managers, supervisors, Medical Directors, and other health programs to overcome 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.
Use negotiation skills to secure appropriate options and services that meet members’ benefit or healthcare needs.
Use influencing and motivational interviewing skills to promote 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 with their providers in healthcare decision-making.
Use 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 in Macon County and surrounding areas.