Intensive Case Management Analyst- Field- Must reside in Jefferson County

CVS Health • Louisville, KY

7d • Onsite

About The Position

Aetna Better Health is hiring for multiple openings across Kentucky. The Case Management Coordinator uses critical thinking and professional judgment to support the case management process and improve member 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 and Jefferson County. It requires regional in-state travel 80–90% of the time, including face-to-face visits with members at homes, schools, hospitals, doctors’ offices, and DCBS offices. Travel to the Louisville office for meetings and training is also anticipated. Candidates must reside in Jefferson County and have reliable transportation. The role requires flexibility to work beyond core business hours of Monday through Friday, 8 a.m. to 5 p.m. EST, to serve children and families who may need support after school or work.

The coordinator evaluates members’ care needs using care management assessments and information review, identifies risks and service needs, and coordinates wellness care plans. The role works with case managers, supervisors, Medical Directors, and other health programs; presents cases for multidisciplinary review; escalates quality-of-care issues; negotiates appropriate services; and uses motivational interviewing, coaching, and education to support member engagement and informed healthcare decisions. The coordinator also documents and monitors care in accordance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

• At least 6 months of experience in foster care and juvenile justice systems, adoption assistance, behavioral health service delivery, 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.
• Ability and willingness to travel 80–90% of the time to meet members face-to-face in the assigned region.
• Must reside in Jefferson County.
• Reliable transportation.
• Bachelor’s or master’s degree in behavioral health or a relevant human services field, such as social work, psychology, marriage and family therapy, or counseling; a non-licensed master-level clinician is also accepted.
• Flexibility to work beyond core business hours of Monday through Friday, 8 a.m. to 5 p.m. EST.

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’ healthcare needs using care management assessments, information and data review, 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 care goals.
• Present cases at case conferences for multidisciplinary review and to support optimal outcomes.
• Identify and escalate quality-of-care issues through established channels.
• Use negotiation skills to secure appropriate options and services to meet members’ benefit and healthcare needs.
• Use influencing and motivational interviewing skills to encourage member engagement and healthy lifestyle or behavior changes.
• Provide coaching, information, and support to empower members to make independent medical and healthy lifestyle choices.
• Help members participate actively and knowledgeably in healthcare decisions with their providers.
• Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Travel throughout the assigned region for face-to-face member visits and travel to the Louisville office for meetings and training.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting colleagues’ physical, emotional, and financial well-being, based on eligibility
• Eligible for a CVS Health bonus, commission, or short-term incentive program

What This Job Offers

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