Case Management Analyst - Field - Must reside in Knox County Illinois

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.

About the role

This Case Management Coordinator position is with Aetna’s Long-Term Services and Supports (LTSS) team and is a field-based role in the Knox County, IL area. The position requires 50-75% travel to meet with members face-to-face. As a Case Management Coordinator, you will facilitate appropriate healthcare outcomes for members by providing care coordination, support, and education through the use of care management tools and resources.

Responsibilities

• Conduct comprehensive evaluations of referred members’ needs and eligibility using care management tools and data review. Recommend approaches to case resolution or meeting needs by evaluating the member’s benefit plan and available internal and external programs/services.
• Identify high-risk factors and service needs that may impact member outcomes and care planning, with appropriate referral to clinical case management or crisis intervention as needed.
• Coordinate and implement assigned care plan activities and monitor care plan progress.
• Consult with case managers, supervisors, Medical Directors, and other health programs to overcome barriers to meeting goals and objectives, using a holistic approach. 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 the member’s benefits and/or healthcare needs.
• Use influencing and motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve 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 processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

• Minimum 2 years of experience in behavioral health, social services, or human services field.
• Minimum 2 years of case management experience.
• Must reside in Knox County, IL (Applicable Zip Codes: 61401, 61402, 61410, 61414, 61428, 61430, 61434, 61436, 61439, 61448, 61449, 61458, 61467, 61472, 61474, 61485, 61488, 61489, 61531, 61544, and 61572).
• Must possess reliable transportation and be willing and able to travel up to 50-75% of the time to meet members face-to-face in Knox County, IL, and surrounding areas. Mileage is reimbursed per company expense reimbursement policy.

Qualifications

• Bachelor’s Degree or non-licensed master’s level clinician required, with either degree in behavioral health or human services (e.g., psychology, social work, marriage and family therapy, counseling).
• Preferred qualifications:
  • Discharge planning experience.
  • Managed care experience.
  • Microsoft Office experience.

Schedule

• Full-time, 40 hours per week.

Pay

The typical pay range for this role is $21.10 - $44.99 per hour. This pay range represents the base hourly rate 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 also eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

Benefits

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. Benefits include:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.