Case Management Coordinator - Field - Southern IL

CVS Health•Centralia, IL

19h

About The Position

The Case Management Coordinator assesses, plans, implements, and coordinates case management activities with members, by phone 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 integrated services, strategies, policies, and programs. Using clinical tools and information and data review, the coordinator evaluates member needs and benefit-plan eligibility, facilitates integrated functions, and supports smooth transitions to Aetna programs and plans. The role applies clinical judgment to reduce risk factors and barriers and address complex health and social indicators affecting care planning and resolution. Assessments consider information from varied sources, including co-morbidities, multiple diagnoses, functionality, work capacity, and related restrictions or limitations. The coordinator reviews prior claims and uses a holistic approach to determine when referrals to clinical resources may help assess functionality. The coordinator consults with supervisors and others to overcome barriers, presents cases at multidisciplinary case conferences, and uses case management processes in compliance with regulatory and company policies and procedures. Interviewing skills are used to engage members and understand their health status and needs.

Requirements

Must reside in southern Illinois and surrounding counties.
At least 2 years of experience in case management, behavioral health, social services, or a related field.
Willing and able to use a personal vehicle for travel 50–75% of the time to meet with members face to face in surrounding areas.
Valid driver’s license; an Illinois license is preferred.
Bachelor’s degree or non-licensed master-level clinician required.
40 hours per week.

Nice To Haves

Long-term care experience.
Case management or discharge planning experience.
Managed care experience.
Microsoft Office (Excel) experience.
A degree in behavioral health or human services is preferred.
Illinois driver’s license is preferred.

Responsibilities

Assess members’ medical needs by phone and/or face to face.
Plan, implement, and coordinate case management activities to support members’ overall wellness.
Develop proactive actions to address member issues and improve short- and long-term outcomes.
Evaluate member needs and benefit-plan eligibility using clinical tools and information and data review.
Facilitate integrated functions and transitions to Aetna programs and plans.
Apply clinical judgment to reduce risk factors and barriers and address complex health and social indicators.
Assess conditions, co-morbidities, multiple diagnoses, functionality, work capacity, and related restrictions or limitations.
Review prior claims for potential impacts on case management and eligibility.
Assess whether referrals to clinical resources are needed to determine functionality.
Consult with supervisors and others to overcome barriers to goals and objectives.
Present cases at case conferences for multidisciplinary review and overall claim management.
Use case management processes in compliance with regulatory and company policies and procedures.
Use interviewing skills to engage members and discern their health status and needs.
Travel in the surrounding areas to meet with members face to face.