Case Management Coordinator - Field - Southern IL

CVS Health • Mount Vernon, IL

2d • $21 - $45

About The Position

The Case Management Coordinator assesses, plans, implements, and coordinates case management activities with members, by telephone and/or face to face, to evaluate medical needs and support overall wellness. The role develops proactive courses of action to address issues and improve short- and long-term outcomes, using clinical tools, information review, and member benefit eligibility to coordinate services and transitions to Aetna programs and plans.

The coordinator applies clinical judgment to reduce risk factors and barriers and address complex health and social indicators affecting care planning. Assessments consider information from multiple sources, including co-morbidities, prior claims, work capacity, restrictions, and limitations. The role takes a holistic approach to identifying referrals to clinical resources, consults with supervisors and others to overcome barriers, and presents cases at multidisciplinary conferences. Work follows regulatory and company policies and procedures, using interviewing skills to engage members and understand their health status and needs.

Requirements

• Reside in southern Illinois or surrounding counties.
• At least 2 years of experience in case management, behavioral health, social services, or a related field.
• Willingness and ability to travel in a personal vehicle 50–75% of the time to meet members face to face in surrounding areas.
• Valid driver's license, preferably in Illinois.
• Bachelor's degree or a non-licensed master's-level clinician.

Nice To Haves

• Long-term care experience.
• Case management or discharge planning experience.
• Managed care experience.
• Microsoft Office, including Excel, experience.
• Degree in behavioral health or human services.

Responsibilities

• Assess, plan, implement, and coordinate case management activities with members by telephone and/or face to face.
• Evaluate members’ medical needs and facilitate their overall wellness.
• Develop proactive courses of action to address issues and improve short- and long-term outcomes.
• Use clinical tools and information or data review to evaluate member needs and benefit plan eligibility and facilitate integrated services and transitions to Aetna programs and plans.
• Apply clinical judgment to reduce risk factors and barriers and address complex health and social indicators that affect care planning and resolution of member issues.
• Assess all relevant conditions, including co-morbidities and multiple diagnoses that affect functionality.
• Review prior claims for potential effects on current case management and eligibility.
• Assess members’ work capacity and related restrictions or limitations.
• Identify the need for referrals to clinical resources to help determine functionality.
• Consult with supervisors and others to overcome barriers to goals and objectives, and present cases at multidisciplinary case conferences.
• Use case management processes in compliance with regulatory and company policies and procedures.
• Use interviewing skills to engage members and determine their health status and needs.

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources, based on eligibility.
• Eligibility for a CVS Health bonus, commission, or short-term incentive program.

What This Job Offers

• Job Type: Full-time