Case Management Analyst – Field – Champaign County Illinois

Position Summary

This Case Management Analyst Field position is with Aetna’s Long-Term Services & Supports (LTSS) team. The requirement is for candidates to travel 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 meeting contractual requirements.

About the role

Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources.

Responsibilities

• Evaluation Of Members Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
• Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
• Carefully coordinates and implements assigned care plan activities and monitors care plan progress.
• Enhance medical appropriateness and quality of care using a holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgeably participate with their provider in healthcare decision-making.

  Requirements

  • Must reside in the state of Illinois in Champaign, IL
  • Valid Illinois Driver’s license
  • Must possess reliable transportation and be willing and able to travel up to 75% of the time.
  • Mileage is reimbursed per our company expense reimbursement policy
  • Minimum of two (2) years of case management experience
  • Microsoft Office and electronic health record experience
  • Case management and discharge planning experience
  • Managed Care experience
  • Microsoft Office experience
  • Experience working with HIV and AIDS population
  • Multi-lingual language proficiency
  • Individual with a bachelor’s degree or a non-licensed individual with a master’s degree, with either degree being in a human-services field (including, but not limited to sociology, special education, rehabilitation counseling)

  Qualifications

  • Required Qualifications
  • Preferred Qualifications

  Skills

  • Case management and discharge planning experience
  • Managed Care experience
  • Microsoft Office experience
  • Experience working with HIV and AIDS population
  • Multi-lingual language proficiency

  Benefits

  Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.