Case Management Coordinator – Field – reside in Sangamon​/Macon

Position Summary

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose‑driven colleagues — caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.

And we do it all with heart, each and every day.
This Case Management Coordinator position is with Aetna’s Long‑Term Services and Supports (LTSS) team and is a field‑based position out of the Sangamon/Macon County and surrounding areas. The requirement is for candidates to travel 50‑75% of the time to meet with members face‑to‑face. As a Case Management Coordinator you will facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.

Travel: 50‑75% travel required. Evaluation of Members:
Through the use of care management tools and information/data review, 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:
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 knowledgeably 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.

• Minimum 2 years of experience in behavioral health, social services or human services field.
• Minimum 2 years of case Management experience.
• Must reside in Sangamon/Macon County or surrounding areas.
• Must possess reliable transportation and be willing and able to travel up to 50‑75% of the time to meet members face‑to‑face in Sangamon and Macon County, and surrounding areas. Mileage is reimbursed per our company expense reimbursement policy.
• Active driver’s license, preferably out of IL.

• Case management and discharge planning experience.
• Managed Care experience.
• Microsoft Office experience.

• Bachelor’s degree or non‑licensed master level clinician required, with either degree being in behavioral health or human services required (psychology, social work, marriage and family therapy, counseling).

Anticipated Weekly

Hours:

40. Time Type:
Full time.

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,…