Case Management Coordinator - Fayette County, IL and Surrounding Areas

CVS Health • Beecher, IL

6d • $21 - $45 • Onsite

About The Position

The Case Management Coordinator conducts routine care coordination, support, and education using care management resources to facilitate appropriate healthcare outcomes for members. The role helps implement Case Management projects, programs, and processes, applying practical knowledge to administer policies, procedures, and plans.

This is a field-based position with Aetna’s Long Term Services & Supports (LTSS) team, serving waiver members in Fayette County and surrounding areas of Illinois. The coordinator manages a full caseload, travels 50–75% of the time to meet members face to face, and completes in-person quarterly member visits. The position supports contractual requirements by facilitating appropriate healthcare outcomes through care coordination, support, and education.

The coordinator evaluates members’ needs and eligibility using care management tools and available information, identifies risk factors and service needs, coordinates and monitors care plans, and refers members to clinical case management or crisis intervention when appropriate. The role works with case managers, supervisors, Medical Directors, and other health programs; presents cases for multidisciplinary review; escalates quality-of-care issues; and helps members access appropriate benefits and services. It also supports member engagement, healthy lifestyle choices, and informed participation 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

• Must reside in Fayette County or surrounding areas in Illinois.
• Must be willing and able to travel up to 75% of the time to meet members face to face.
• Reliable transportation required; eligible for mileage reimbursement under company policy.
• At least 2 years of experience in Behavioral Health, Social Services, or a Human Services field.
• At least 2 years of case management experience.
• Valid driver’s license, preferably issued in Illinois.
• Bachelor’s degree in Behavioral Health or Human Services, or a master’s degree in those fields for a non-licensed individual. Examples include social work, psychology, sociology, special education, and rehabilitation 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, information, and data.
• Recommend approaches to resolve cases or meet member needs based on benefit plans and available internal and external resources.
• Identify high-risk factors and service needs that may affect member outcomes and care planning, and refer members to clinical case management or crisis intervention as appropriate.
• Coordinate 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 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 influencing and motivational interviewing skills to promote member engagement and lifestyle or behavior changes.
• Provide coaching, information, and support to help members make independent medical and healthy lifestyle choices.
• Help members participate actively and knowledgeably with providers in healthcare decisions.
• Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Manage a full caseload of waiver members and conduct in-person quarterly member visits.
• Travel to meet members face to face, with travel expected up to 75% of the time.

Benefits

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

What This Job Offers

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