Case Management Analyst – Field in Macon County Illinois

CVS Health • Decatur, IL

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About The Position

This field-based position supports Aetna’s Long-Term Services and Supports (LTSS) team in Macon County, Illinois. The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing care coordination, support, and education through care management tools and resources. The role requires travel 50–75% of the time to meet members face to face in Macon County and surrounding areas; mileage is reimbursed under the company expense reimbursement policy.

The role evaluates referred members’ needs and eligibility using care management tools and data, recommends approaches to resolve cases or meet needs, and considers members’ benefit plans and available programs and services. It identifies high-risk factors and service needs that may affect outcomes and care planning, with referrals to clinical case management or crisis intervention as appropriate. The position coordinates and implements care plan activities and monitors progress.

Using a holistic approach, the coordinator works with case managers, supervisors, Medical Directors, and other health programs to address barriers, and presents cases for multidisciplinary review. The role escalates quality-of-care issues, negotiates to secure appropriate services, and uses motivational interviewing and influencing skills to engage members and support healthy behavior changes. It provides coaching and information to help members make independent healthcare and lifestyle choices and participate knowledgeably in decisions with their providers. The coordinator also follows case management and quality management processes 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 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 data, and recommend approaches to resolve cases or meet needs.
• Review members’ 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 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 address barriers to care goals.
• Present cases at case conferences for multidisciplinary review.
• Identify and escalate quality-of-care issues through established channels.
• Negotiate to secure appropriate options and services to meet members’ benefits and healthcare needs.
• Use influencing and motivational interviewing skills to engage members and promote lifestyle and behavior changes.
• Provide coaching, information, and support to empower members to make independent medical and healthy lifestyle choices.
• Help members participate knowledgeably in healthcare decision-making with their providers.
• Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Meet members face to face in Macon County and surrounding areas, with 50–75% travel required.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources to support colleagues’ and families’ physical, emotional, and financial well-being, based on eligibility
• Eligibility for a CVS Health bonus, commission, or short-term incentive program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level