Case Management Analyst - Remote - IL

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 life‑changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. Position Summary / Mission The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Coordinator facilitates appropriate healthcare outcomes for members by aiding with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources. Key Responsibilities Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members’ needs/eligibility and recommends an approach to case resolution and/or meeting needs based on benefit plan and available internal and external programs/services. Identifies high‑risk factors and service needs that may impact member outcomes and coordinates and implements assigned care plan activities while monitoring progress. Enhancement of Medical Appropriateness and Quality of Care: Consults with case managers, supervisors, Medical Directors and other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences for multidisciplinary review to achieve optimal outcomes. Identifies and escalates quality of care issues, secures appropriate options and services, and employs motivational interviewing to promote maximum member engagement and lifestyle/behavior changes. Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies. Maintains accurate and timely documentation of all care activities. Remote Work Expectations Candidates must have a dedicated workspace free of interruptions. Dependents must have separate care arrangements during work hours; continuous care responsibilities during shift times are not permitted. Interacts with members/clients telephonically or in person, and may be required to meet with members/clients in homes, worksites, or physician’s offices for ongoing case management services. Required Qualifications Bachelor’s degree or non‑licensed master level clinician in behavioral health or human services (nursing, psychology, social work, marriage and family therapy, counseling). Ability to travel within a designated geographic area for in‑person case management activities as directed by Leadership. Computer literacy, including navigation of internal/external systems, Excel and Microsoft Word. Preferred Qualifications Case management and discharge planning experience; minimum 2 years’ experience in behavioral health, social services or related field. Managed Care experience. Effective communication, telephonic and organizational skills. Excellent analytical and problem‑solving skills. Ability to work independently and participate effectively in a multidisciplinary team. Pay Range The typical pay range for this role is $21.10–$44.99 per hour. The actual base salary will depend on experience, education, geography and other factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range. 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. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr