Analyst, Case Management

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. Position Summary 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 Macon County area of Illinois.  The requirements 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. Evaluation of Members: • 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. o 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. o Coordinates and implements assigned care plan activities and monitors care plan progress. • Enhancement of Medical Appropriateness and Quality of Care: o 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. o Identifies and escalates quality of care issues through established channels. o Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs. o Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. o Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. o Helps member actively and knowledgeably participate with their provider in healthcare decision-making. • Monitoring, Evaluation and Documentation of Care: o 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 Macon County Illinois 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. Preferred Qualifications • Case management and discharge planning experience preferred • Managed Care experience preferred • Microsoft Office experience preferred 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) Anticipated Weekly Hours 40 Time Type Full time Pay Ran