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

CVS Health•Louisville, KY

7d•Onsite

About The Position

Aetna Better Health is hiring multiple Case Management Coordinator (CMC) openings across Kentucky. The CMC uses critical thinking and professional judgment to support case management and facilitate improved healthcare outcomes for members through advocacy, coordination, support, and education, using care management tools and resources. This is a field position assigned to the Jefferson Region, Jefferson County, and requires the candidate to reside in Jefferson County. The role involves regional in-state travel 80–90% of the time, with visits to members’ homes, schools, hospitals, doctors’ offices, and DCBS offices for face-to-face member contact. Reliable transportation is required. Travel to the Louisville office for meetings and training is also anticipated. Flexibility to work beyond core business hours of Monday through Friday, 8 a.m.–5 p.m. EST, is required to serve children and families who may need support after school or work. The role evaluates member needs using care management assessments and information review; identifies risks and service needs; coordinates wellness care plans; collaborates with case managers, supervisors, Medical Directors, and other programs; escalates quality-of-care concerns; supports member engagement and healthy choices; and documents care in accordance with applicable regulatory, accreditation, and company requirements.

Requirements

At least 6 months of experience in foster care and juvenile justice systems, Adoption Assistance, delivery of 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.
Reliable transportation is required.
Flexibility to work beyond core business hours of Monday through Friday, 8 a.m.–5 p.m. EST.
A bachelor’s or master’s degree, or a non-licensed master-level clinician qualification, in behavioral health or a relevant human services field such as social work, psychology, marriage and family therapy, or counseling.

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 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 member 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 support optimal outcomes.
Identify and escalate quality-of-care issues through established channels.
Use negotiation skills to secure appropriate options and services that meet members’ benefits and healthcare needs.
Use influencing and motivational interviewing skills to encourage member engagement and 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 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 to meet members face to face in their assigned region and attend meetings and training at the Louisville office.