Case Management Analyst - Remote - IL

CVS Health•Work At Home-Illinois, IL

1d•$21 - $45•Remote

About The Position

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

Requirements

Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services required (nursing, psychology, social work, marriage and family therapy, counseling).
Ability to travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise
Must have computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.

Nice To Haves

Case management and discharge planning experience preferred
2 years’ experience in behavioral health, social services or appropriate related field equivalent to program focus
Managed Care experience preferred
Effective communication, telephonic and organization skills
Excellent analytical and problem-solving skills
Ability to work independently
Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Responsibilities

Utilizes critical thinking and judgment to collaborate and inform the case management process.
Facilitates appropriate healthcare outcomes for members by aiding with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources.
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.
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 knowledgably participate with their provider in healthcare decision-making.
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Interacts with members/clients telephonically or in person.
May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services.