Case Management Analyst - Field in Macoupin County IL

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Case Manager Analyst – Field

Location:

Macoupin County & Surrounding Areas, IL. Must reside in one of the following 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 Macoupin County & Surrounding Areas, IL. 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.

• Must reside in the state of Illinois Macoupin County & Surrounding Areas, 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…