Case Management Analyst - Must live near Aurora, Naperville, or Joliet IL

CVS Health•Field Township, IL

11d•$21 - $45•Hybrid

About The Position

This Case Management Analyst Field position is with Aetna’s Long-Term Services & Supports (LTSS) team and is a field-based position out of the Naperville, Joliet or Aurora area of Illinois. The requirement is for candidates to travel 50-75% of the time to meet with members face to face. This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meeting contractual requirements. Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources. Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. Coordinates and implements assigned care plan activities and monitors care plan progress. Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes. Identifies and escalates quality of care issues through established channels. Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs. Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Helps member actively and knowledgeably participate with their provider in healthcare decision-making. Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

Must reside in the state of Illinois in the Naperville, Joliet or Aurora area of Illinois.
Valid Illinois Driver’s license
Must possess reliable transportation and be willing and able to travel up to 75% of the time.
Minimum of two (2) years of case management experience
Microsoft Office and electronic health record experience
Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer
A minimum download speed of 25 mbs download and 3 mbs upload. Wi-Fi and satellite internet are not permitted.
A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines and allowing for uninterrupted work during work hours.
Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
Commit to obtaining required internet speeds and adhere to all Work from Home requirements.
Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
Ability to resolve common technical issues independently, such as restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
Openness to learning new skills in the future as the workplace environment evolves.

Nice To Haves

Case management and discharge planning experience
Managed Care experience
Microsoft Office experience
Experience working with HIV and AIDS population
Multi-lingual language proficiency

Responsibilities

Conduct comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
Identify high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
Coordinate and implement assigned care plan activities and monitor care plan progress.
Consult with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives.
Present cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
Identify and escalate quality of care issues through established channels.
Utilize negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
Utilize influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
Provide coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
Help member actively and knowledgeably participate with their provider in healthcare decision-making.
Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.