Analyst, Case Mgt Field

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.

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. 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.

• Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members’ needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members’ benefit plan and available internal aid 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.
• Coordinates and implements assigned care plan activities and monitors care plan progress.

• Using 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.

• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

• Must reside in the state of Illinois in Rock Island area
• Valid Illinois Driver’s license
• Willing and able to travel up to 75% of their 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
• NOTE:
  
  If position is intended to manage HIV/AIDs HCBS Waiver members, It is mandatory that individuals have experience in working with racial and ethnic minorities, as well as one or more of the following: domestic abuse; the lesbian, gay, bisexual, transgender, queer (LBGTQ+) community;
  Persons living with HIV/AIDS Persons with substance use disorders.

• Case management and discharge planning experience preferred
• Managed Care experience preferred
• Microsoft…