Intensive Case Management Analyst- Field- Must reside in Jefferson County

Start free →

Or apply yourself on the official page →

About the role

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 Aetna Better Health is hiring for multiple openings across the state/regions of Kentucky. Case Management Coordinator (CMC) utilizes critical thinking and professional judgment to support the case management process, in order to facilitate and maintain improved healthcare outcomes for members by providing advocacy, collaboration coordination, support and education for members through the use of care management tools and resources. This is a Field position that requires regional in-state travel 80-90% of the time. Qualified candidate must have reliable transportation. Travel to the Louisville office for meetings and training is also anticipated. Travel to member's homes, schools, hospitals, doctor's offices, DCBS offices etc. is expected for member face to face time.  This position is assigned to the Jefferson Region Jefferson County. Qualified candidates must reside in Jefferson county in the assigned region. Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm EST, is required. We are serving the needs of children and families that may require working after school, after work, etc. Evaluation of Members: - Through the use of care management assessments and information/data review, recommends an approach to resolving care needs maintaining optimal health and well-being 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 implements early and proactive support interventions. - Coordinates and implements Wellness care plan activities and monitors member care needs. 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 knowledgably 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 -Minimum 6 months experience in Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services or evidence-based practices applicable to the Kentucky SKY populations, is required. -Minimum 2 year of experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling. - Minimum 1 year of experience in MS Office Suite applications, includin

View the official posting →