Analyst, Case Mgt Field

About the role

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

This Analyst, Case Management Field position is with Aetna’s Long Term Services & Supports (LTSS) team and is a field-based position out of the Rock Island County area of Illinois. The requirement is for candidates to travel 50-75% of the time to meet with members face to face. This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meet contractual requirements.

Responsibilities

• Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education through the use of care management tools and resources.
• Conduct comprehensive evaluations of referred members' needs/eligibility using care management tools and information/data review; recommend approaches to case resolution and/or meeting needs by evaluating benefit plans and available internal aid and external programs/services.
• Identify high‑risk factors and service needs that may impact member outcomes and care planning; make appropriate referrals to clinical case management or crisis intervention as needed.
• Coordinate and implement assigned care plan activities and monitor care plan progress.
• Use a holistic approach to consult with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to goals; present cases at case conferences for multidisciplinary review to achieve optimal outcomes.
• Identify and escalate quality‑of‑care issues through established channels.
• Utilize negotiation skills to secure appropriate options and services necessary to meet members' benefits and/or healthcare needs.
• Apply influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes for optimum health.
• Provide coaching, information and support to empower members to make ongoing independent medical and/or healthy lifestyle choices.
• Help members actively and knowledgeably participate with their providers in healthcare decision‑making.
• Utilize case management and quality management