[Hiring] Analyst, Case Management @CVS Health

Role Description

This is a full-time telework position open to candidates in the United States. Schedule for this position is Monday-Friday 8:00a-5:00p EST.

Program Overview: Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have lifechanging impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.

Position Summary/Mission: The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources.

• Evaluation of Members:
  • 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:
  • Consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives.
  • 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.

Qualifications

• 2+ years experience in behavioral health or social services
• Must have the ability to work 8:00a-5:00p EST
• 2+ years of experience with Microsoft Office applications (Word, Excel, Outlook)

Requirements

• Case management and discharge planning experience
• Managed Care experience

Education

• Bachelor's degree or non-licensed master level clinician with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling) or equivalent experience.

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility