5K New Hire Bonus! Case Manager Behavioral Health (Field - Chinatown area) Preferred Bilingual

Position Summary

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges.

Family Summary/Mission

• Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.
• Develops, implements, and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.
• Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.

Position Summary/Mission

Our Case Managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.

Fundamental Components & Physical Requirements

• Assessment Of Members Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member’s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.
• Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
• Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
• Enhancement of Medical Appropriateness and Quality of Care: Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health.
• Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
• Monitoring, Evaluation And Documentation Of Care In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Remote Work Expectations

• This is a remote-hybrid role; candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.
• Mileage is reimbursed per our company expense reimbursement policy.

Required Qualifications

• Must reside in Illinois
• 3-5 years clinical practical experience
• 2-3 years CM, discharge planning and/or home health care coordination experience
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
• Must possess reliable transportation and be willing and able to travel up to 50-75% in Southloop, Chinatown and surrounding areas.

Preferred Qualifications

• Certified Case Manager is preferred
• Bilingual in English AND Cantonese or Mandarin

Education

• Master’s Degree in Behavioral/Mental Health or related field

Licenses/Certifications

• LCSW or LCPC in the state of Illinois

Anticipated Weekly Hours

• 40

Pay Range

The Typical Pay Range For This Role Is $0.00 - $0.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.