Case Management Analyst - Field in Roanoke Virginia

CVS Health•Rocky Mount, VA

19h•$21 - $41•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 members face to face. The analyst collaborates in the case management process to support appropriate healthcare outcomes through care coordination, support, and education, using care management tools and resources. The role evaluates members’ needs and eligibility, recommends approaches to resolve cases or meet needs, and considers benefit plans and available internal and external programs and services. The analyst coordinates and monitors assigned care plan activities, identifies risk factors and service needs, and makes appropriate referrals, including to clinical case management or crisis intervention. Using a holistic approach, the analyst works with case managers, supervisors, Medical Directors, and other health programs to address barriers, participates in case conferences, and escalates quality-of-care issues through established channels. The role also involves negotiating for appropriate services, motivational interviewing, coaching members toward independent health and lifestyle choices, and helping them participate knowledgeably in healthcare decisions. Case management and quality management processes must be followed 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

Use critical thinking and judgment to collaborate in the case management process and facilitate appropriate healthcare outcomes through care coordination, support, and education.
Use care management tools and information to evaluate members, conduct comprehensive assessments of needs and eligibility, and recommend approaches to resolving cases or meeting needs.
Evaluate members’ 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 and implement assigned care plan activities and monitor progress.
Consult with case managers, supervisors, Medical Directors, and other health programs to overcome barriers to care 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 for members’ benefits and healthcare needs.
Use motivational interviewing to support member engagement and lifestyle or behavior changes.
Provide coaching, information, and support that empower members to make independent medical and healthy-lifestyle choices.
Help members participate actively and knowledgeably with 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, up to 75% of the time.