[Hiring] Case Management Analyst @CVS Health

Role Description

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 Lake County 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 and 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 through the use of care management tools and resources.

Evaluation of Members

• Conduct comprehensive evaluation of referred member’s needs/eligibility and recommend an approach to case resolution by evaluating member’s benefit plan and available internal and external programs/services.
• Identify 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.
• Coordinate and implement assigned care plan activities and monitor care plan progress.

Enhancement of Medical Appropriateness and Quality of Care

• Consult with case managers, supervisors, Medical Directors, and/or other health programs to overcome barriers to meeting goals and objectives.
• Present cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Identify and escalate quality of care issues through established channels.
• Utilize negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provide coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Help member actively and knowledgeably participate with their provider in healthcare decision-making.

Monitoring, Evaluation and Documentation of Care

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

Qualifications

• Must reside in the state of Illinois in Lake or DuPage County Illinois.
• 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

• Discharge planning experience.
• Managed Care experience.
• Multi-lingual language proficiency.

Required Education

• Bachelor’s degree or a non-licensed individual with a master’s degree in a human-services field (including, but not limited to sociology, special education, rehabilitation counseling).

Work from Home Requirements

• Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer.
• 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.
• 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).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work from Home requirements.

Technical and Logistical Requirements

• Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Ability to log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Ability to resolve common technical issues independently, such as restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Openness to learning new skills in the future as the workplace environment evolves.

Anticipated Weekly Hours

• 40

Time Type

• Full time

Pay Range

The typical pay range for this role is $21.10 - $44.99. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above.

Benefits

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include:

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

Additional details about available benefits are provided during the application process.