Intensive Case Management Analyst- Field- Must Reside in Jefferson County KY

CVS Health•Louisville, KY

21h•Onsite

About The Position

Aetna Better Health is hiring for multiple openings across the state/regions of Kentucky. The Case Management Coordinator (CMC) utilizes critical thinking and professional judgment to support the case management process, in order to facilitate and maintain improved healthcare outcomes for members by providing advocacy, collaboration, coordination, support, and education for members through the use of care management tools and resources. This is a Field position that requires regional in-state travel 80-90% of the time. Qualified candidates must have reliable transportation. Travel to the Louisville office for meetings and training is also anticipated. Travel to member's homes, schools, hospitals, doctor's offices, DCBS offices, etc., is expected for member face-to-face time. This position is assigned to the Jefferson Region, Jefferson County. Qualified candidates must reside in Jefferson County in the assigned region. Flexibility to work beyond core business hours of Monday-Friday, 8 am-5 pm EST, is required. We are serving the needs of children and families that may require working after school, after work, etc. The role involves the evaluation of members through care management assessments and information/data review, recommending approaches to resolving care needs, maintaining optimal health and well-being by evaluating member’s benefit plan and available internal and external programs/services. It also includes identifying high-risk factors and service needs that may impact member outcomes and implementing early and proactive support interventions, as well as coordinating and implementing Wellness care plan activities and monitoring member care needs. The role also focuses on the enhancement of medical appropriateness and quality of care through a holistic approach, consulting with case managers, supervisors, Medical Directors, and/or other health programs to overcome barriers to meeting goals and objectives. It involves presenting cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes, identifying and escalating quality of care issues through established channels, and utilizing negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs. Additionally, it requires utilizing influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum levels of health, providing coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices, and helping members actively and knowledgeably participate with their provider in healthcare decision-making. Finally, the role involves utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

Minimum 6 months experience in Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services or evidence-based practices applicable to the Kentucky SKY populations, is required.
Minimum 2 years of experience in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
Minimum 1 year of experience in MS Office Suite applications, including Word and Excel.
Willing and able to travel 80-90% of their time to meet members face to face in their assigned region.
Candidate must reside in Jefferson County.

Nice To Haves

3+ years' experience in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
1+ years of MCO experience.

Responsibilities

Utilizes critical thinking and professional judgment to support the case management process.
Facilitates and maintains improved healthcare outcomes for members by providing advocacy, collaboration, coordination, support, and education.
Evaluates member's benefit plan and available internal and external programs/services.
Identifies high risk factors and service needs that may impact member outcomes and implements early and proactive support interventions.
Coordinates and implements Wellness care plan activities and monitors member care needs.
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 knowledgeably 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.