Case Management Analyst - Must live near Aurora, Naperville, or Joliet IL

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.

About the role

This Analyst, Case Management Field position is with Aetna’s Long Term Services & Supports (LTSS) team and is a field-based position. Candidates must reside in or near the Naperville, Joliet, or Aurora area of Illinois and be willing to travel 50-75% of the time to meet with members face-to-face. This position holds a full caseload to manage waiver members and requires in-person quarterly visits to meet contractual requirements.

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

Responsibilities

• Conduct comprehensive evaluation of referred members' needs/eligibility using care management tools and information/data review. Recommend an approach to case resolution and/or meeting needs by evaluating members' benefit plan and available internal and external programs/services.
• Identify 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 needed.
• Coordinate and implement assigned care plan activities and monitor care plan progress.
• Consult with case managers, supervisors, Medical Directors, and/or other health programs to overcome barriers to meeting goals and objectives using a holistic approach. Present cases at case conferences to obtain multidisciplinary review for 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/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 provider in healthcare decision-making.
• Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

• Must reside in the state of Illinois in or near Naperville, Joliet, or Aurora.
• Valid Illinois Driver’s license.
• Willing and able to travel up to 75% of the time to meet with members face-to-face.
• Reliable transportation required; eligible for mileage reimbursement as per company policy.
• Minimum of two (2) years of case management experience.
• Microsoft Office and electronic health record experience.

Qualifications

• Bachelor’s degree or a non-licensed individual with a master’s degree in a human-services field (including, but not limited to sociology, special education, rehabilitation counseling).

Preferred Qualifications

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

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 eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above.

Schedule

• Full-time position.
• Anticipated weekly hours: 40.

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, including:

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