Case Management Coordinator - Fayette County, IL and Surrounding Areas

CVS Health • Clinton, IL

4d • Onsite

About The Position

This Analyst, Case Management Field position is with Aetna’s Long Term Services & Supports (LTSS) team and is field-based in Fayette County and surrounding areas of Illinois. The coordinator manages a full caseload of waiver members and conducts routine care coordination, support, and education using care-management resources to facilitate appropriate healthcare outcomes. The role includes in-person quarterly member visits and requires travel to meet members face to face. The position is critical to meeting contractual requirements.

The coordinator evaluates referred members’ needs and eligibility using care-management tools and information, recommends approaches to case resolution, and considers benefit plans and available internal and external programs and services. The role identifies high-risk factors and service needs, coordinates and monitors care-plan activities, and refers members to clinical case management or crisis intervention when appropriate.

The coordinator works with case managers, supervisors, Medical Directors, and other health programs to address barriers to care goals, presents cases for multidisciplinary review, escalates quality-of-care concerns, and negotiates for appropriate services. The role uses motivational interviewing and coaching to encourage member engagement, support healthy lifestyle choices, and help members participate knowledgeably in healthcare decisions. Care and documentation activities must comply with regulatory and accreditation guidelines and company policies and procedures.

Requirements

• Must reside in Fayette County or surrounding areas of Illinois.
• Must be willing and able to travel up to 75% of the time to meet members face to face.
• Reliable transportation is required; eligible for mileage reimbursement according to company policy.
• At least 2 years of experience in Behavioral Health, Social Services, or Human Services.
• 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 for a non-licensed individual, in a qualifying field such as social work, psychology, sociology, special education, or rehabilitation counseling.

Nice To Haves

• Case-management and discharge-planning experience.
• Managed Care experience.
• Microsoft Office experience.

Responsibilities

• Conduct routine care coordination, support, and education for members using care-management resources.
• Manage a full caseload of waiver members and conduct in-person quarterly visits.
• Evaluate referred members’ needs and eligibility, review benefit plans and available programs or services, and recommend approaches to case resolution.
• Identify high-risk factors and service needs, and refer members to clinical case management or crisis intervention when appropriate.
• Coordinate assigned care-plan activities and monitor 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 for appropriate options and services to meet members’ benefit and healthcare needs.
• Use motivational interviewing, coaching, information, and support to promote member engagement, behavior change, and independent healthcare decisions.
• Help members participate actively and knowledgeably in healthcare decision-making with their providers.
• Apply case-management and quality-management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Help implement Case Management projects, programs, processes, policies, procedures, and plans.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• CVS Health bonus, commission, or short-term incentive program, subject to eligibility

What This Job Offers

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