Case Management Analyst - Field in Harrisonburg, VA

CVS Health•Staunton, VA

7d•$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 Harrisonburg, Virginia region. The role requires frequent face-to-face member visits and travel of up to 75% of the time. 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 role evaluates members’ needs and eligibility, identifies risks and service needs, recommends approaches to resolve cases, and coordinates and monitors care plan activities. The analyst works with case managers, supervisors, Medical Directors, and other health programs to address barriers, participates in multidisciplinary case conferences, escalates quality-of-care issues, and helps members engage in healthcare decisions and healthy lifestyle choices. Case management and quality management work must comply 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 Harrisonburg, 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, preferably 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.
LTSS experience.
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 member 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 case resolution or meeting identified 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 address barriers to goals and objectives; present cases at multidisciplinary case conferences.
Identify and escalate quality-of-care issues through established channels.
Use negotiation skills to secure appropriate options and services to meet members’ benefits and healthcare needs.
Use motivational interviewing to promote member engagement and lifestyle or behavior changes that support health goals.
Provide coaching, information, and support to empower members to make independent medical and healthy-lifestyle choices.
Help members participate knowledgeably and actively 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.
Travel to meet members face to face in the Harrisonburg region.