Case Management Analyst - Field in the West Side of Chicago, IL - New Hire Bonus Available

CVS Health•Chicago, IL

About The Position

The Case Management Analyst – Field position is part of Aetna’s Long-Term Services & Supports (LTSS) team and is based in the west side of Chicago, Illinois. The role manages a full caseload of waiver members and requires travel 50–75% of the time for face-to-face visits, including quarterly in-person member visits. The position is important to meeting contractual requirements. The analyst facilitates appropriate health outcomes for waiver/LTSS members through care coordination, support, and education, using care management tools and resources. The role evaluates member needs and eligibility, identifies risk factors and service needs, coordinates and monitors care plan activities, and connects members with appropriate clinical case management, crisis intervention, and internal or external services. Working with case managers, supervisors, Medical Directors, and other health programs, the analyst addresses barriers to care and participates in case conferences. The position also supports member engagement and informed decision-making through coaching, motivational interviewing, negotiation, and education. Care and documentation must comply with regulatory and accreditation guidelines and company policies. This is a field-based position with work-from-home requirements for designated work periods. The company provides computer and related equipment; colleagues provide their own workspace furniture. The role requires a secure, private home workspace, a hardwired internet connection meeting specified speeds, and the ability to use digital communication, office, and secure healthcare systems. The position is full-time, with 40 anticipated weekly hours.

Requirements

Must reside in Illinois in the west side of the Chicago area.
Valid Illinois driver’s license.
Reliable transportation and ability and willingness 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.
A bachelor’s degree in a human-services field, or a master’s degree for a non-licensed individual, in a human-services field such as sociology, special education, or rehabilitation counseling.
Must have or be able to obtain a direct, hardwired internet connection to a modem/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 home work location that complies with CVS Health and HIPAA guidelines and allows uninterrupted work.
Must work from within the state and city where the colleague has confirmed they currently live.
Must provide workspace furniture, such as a desk or standing desk, and be able to work at a desk for extended periods.
Ability to set up and use multiple monitors and navigate multiple applications simultaneously.
Ability to communicate through email, calendar invitations, Teams messaging, and virtual meetings.
Ability to use Microsoft Office 365 applications, including Teams, Outlook, Word, Excel, and PowerPoint, or similar tools such as Google Workspace.
Ability to access secure systems such as VPN and EHR portals, secure the computer when unattended, manage strong passwords, and recognize suspicious emails or links.
Ability to troubleshoot common technical issues independently and contact IT for unresolved issues.
Openness to learning new skills as the workplace environment evolves.

Nice To Haves

Case management and discharge planning experience.
Managed care experience.
Experience working with HIV and AIDS populations.
Multilingual language proficiency.

Responsibilities

Manage a full caseload of waiver members and conduct required in-person quarterly visits.
Travel to meet members face to face, with travel expected 50–75% of the time.
Facilitate appropriate healthcare outcomes for waiver/LTSS members through care coordination, support, and education.
Evaluate referred members’ needs and eligibility using care management tools and information or data review; recommend approaches to resolving cases and meeting needs.
Review 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 assigned care plan activities and monitor progress.
Consult with case managers, supervisors, Medical Directors, and other health programs to address barriers to care goals.
Present cases at case conferences for multidisciplinary review.
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 engage members and promote lifestyle or behavior changes.
Coach and support members so they can make independent medical and healthy-lifestyle choices and participate knowledgeably in healthcare decisions.
Use case management and quality management processes and document care in compliance with regulatory and accreditation guidelines and company policies and procedures.
Use digital communication and collaboration tools, secure systems, and multiple applications; resolve common technical issues or contact IT for unresolved issues.