Analyst, Case Management
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Job Description
Aetna LTSS case management analyst coordinating care, education, and support for waiver members. Conducting face-to-face visits and managing contractual care outcomes in Illinois.
Responsibilities:
- Facilitate appropriate healthcare outcomes for waiver/LTSS members through care coordination, support, and education
- Conduct comprehensive evaluations of referred members’ needs and eligibility
- Recommend case-resolution approaches by evaluating benefit plans and internal and external programs/services
- Identify high-risk factors and service needs affecting member outcomes and care planning
- Refer members to clinical case management or crisis intervention when appropriate
- Coordinate and implement assigned care-plan activities and monitor progress
- Consult with case managers, supervisors, Medical Directors, and other health programs to overcome barriers
- Present cases at case conferences for multidisciplinary review
- Identify and escalate quality-of-care issues
- Negotiate appropriate options and services to meet members’ benefit and healthcare needs
- Use influencing and motivational interviewing skills to engage members and promote lifestyle or behavior changes
- Provide coaching, information, and support for independent medical and healthy-lifestyle choices
- Help members participate knowledgeably in healthcare decision-making with providers
- Apply case-management and quality-management processes in compliance with regulatory, accreditation, and company requirements
- Travel 50–75% and conduct in-person quarterly member visits
Requirements:
- Must reside in the state of Illinois in Rock Island 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
- Minimum of two (2) years of case management experience
- Microsoft Office and electronic health record experience
- If managing HIV/AIDS HCBS Waiver members: experience working with racial and ethnic minorities and one or more of domestic abuse, the LGBTQ+ community, persons living with HIV/AIDS, or persons with substance use disorders
- Case management and discharge planning experience preferred
- Managed Care experience preferred
- Bachelor’s degree or non-licensed master’s degree in a human-services field, including sociology, special education, or rehabilitation counseling
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to base pay range
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility
- Mileage reimbursement as per company policy
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