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

CVS Health•Louisville, KY

16h•$21 - $37•Onsite

About The Position

Aetna Better Health is hiring for multiple openings across Kentucky. The Case Management Coordinator (CMC) uses critical thinking and professional judgment to support case management and help improve members’ healthcare outcomes through advocacy, collaboration, coordination, support, and education, using care management tools and resources. This is a field position assigned to the Jefferson Region in Jefferson County, Kentucky. It requires regional in-state travel 80–90% of the time, including visits to members’ homes, schools, hospitals, doctors’ offices, and DCBS offices for face-to-face time. Travel to the Louisville office for meetings and training is also anticipated. Candidates must have reliable transportation and reside in Jefferson County. Flexibility to work beyond the core Monday–Friday, 8 a.m.–5 p.m. EST business hours is required to serve children and families, including after-school and after-work needs. The role evaluates members’ care needs, identifies risk factors, coordinates wellness care plans, and monitors member needs. It works with case managers, supervisors, Medical Directors, and other health programs to address barriers and achieve care goals, including presenting cases for multidisciplinary review. The CMC identifies and escalates quality-of-care issues, negotiates for appropriate services, promotes member engagement and healthy behavior changes, coaches and supports members in making informed healthcare choices, and applies case- and quality-management processes in accordance with regulatory, accreditation, and company requirements.

Requirements

At least 6 months of experience in foster care and juvenile justice systems, adoption assistance, behavioral health services, trauma-informed care, ACEs, crisis intervention services, or evidence-based practices applicable to Kentucky SKY populations.
At least 2 years of experience in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
At least 1 year of experience using MS Office Suite applications, including Word and Excel.
Willingness and ability to travel 80–90% of the time to meet members face to face in the assigned region.
Must reside in Jefferson County, Kentucky.
A bachelor’s or master’s degree, or a non-licensed master-level clinician qualification, is required; the degree must be in behavioral health or a relevant human services field such as social work, psychology, marriage and family therapy, or counseling.
Reliable transportation.
Flexibility to work beyond core Monday–Friday, 8 a.m.–5 p.m. EST business hours.

Nice To Haves

At least 3 years of experience in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
At least 1 year of managed care organization (MCO) experience.

Responsibilities

Evaluate members’ care needs using care management assessments and information and data review, considering benefit plans and available internal and external programs and services.
Identify high-risk factors and service needs that may affect member outcomes, and implement early, proactive support interventions.
Coordinate and implement wellness care plan activities and monitor members’ care needs.
Consult with case managers, supervisors, Medical Directors, and other health programs to address barriers to goals and objectives.
Present cases at case conferences for multidisciplinary review to help achieve optimal outcomes.
Identify and escalate quality-of-care issues through established channels.
Negotiate to secure appropriate options and services that meet members’ benefit and healthcare needs.
Use influencing and motivational interviewing skills to engage members and encourage lifestyle or behavior changes.
Provide coaching, information, and support to empower members to make ongoing independent medical and healthy-lifestyle choices.
Help members participate actively and knowledgeably with their providers in healthcare decision-making.
Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Travel throughout the assigned region to meet members face to face and travel to the Louisville office for meetings and training.