Case Management Analyst - Field in the West Side of Chicago, IL

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Position Summary
- Case Manager Analyst
- Field

Location:

West Side of Chicago in Zip Codes; , (Elmwood Park, Oak Park, Forrest Park
- Within 5-7 Miles of these locations/zip codes) This Case Management Analyst Field position is with Aetna's Long-Term Services & Supports (LTSS) team and is a field-based position out of the west side of Chicago 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 meeting 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. 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.

Coordinates and implements assigned care plan activities and monitors care plan progress.

Enhancement of Medical Appropriateness and Quality of Care:

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.

Monitoring, Evaluation and Documentation of Care:

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

Required Qualifications:

Must reside in the state of Illinois in the west side of Chicago area 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

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

Required

Education:

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)
Work from Home Requirements:
You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and A minimum download speed of 25 mbs download and 3 mbs upload. Wi-Fi and satellite internet are not permitted. A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines and allowing for uninterrupted work during work hours.

Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.

The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).If hired, you will commit to obtaining required internet speeds and adhere to all Work from Home requirements. Technical and Logistical Requirements:
Device & System Navigation:
Comfortable setting up and using multiple monitors and navigating multiple applications…