Case Manager

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 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 Knox County IL Area. The requirements 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. 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. Required Qualifications Minimum 2 years of experience in behavioral health, social services or human services field Minimum 2 years of case management experience Must reside in Knox County IL (Applicable Zip Codes: 61401, 61402, 61410, 61414, 61428, 61430, 61434, 61436, 61439, 61448, 61449, 61458, 61467, 61472, 61474, 61485, 61488, 61489, 61531, 61544, and 61572) 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 the Knox County, IL, and surrounding areas. Mileage is reimbursed per our company expense reimbursement policy Preferred Qualifications Discharge planning experience Managed care experience Microsoft Office experience Education 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 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. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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, and other resources, based on eligibility. medical coverage dental coverage 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 and on Benefits Moments. We anticipate the application window for this opening will close on: 08/31/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr