Case Management Coordinator - IL

Case Management Coordinator

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.

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. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Case Management 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 include:

• Evaluation of members through the use of care management tools and information/data review, conducting comprehensive evaluation of referred member's needs/eligibility and recommending an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
• Identifying 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.
• Coordinating and implementing assigned care plan activities and monitoring care plan progress.
• Using a holistic approach to consult with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presenting cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Identifying and escalating quality of care issues through established channels.
• Utilizing negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
• Utilizing influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Providing coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helping member actively and knowledgably participate with their provider in healthcare decision-making.
• Utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Remote work expectations include:

• Candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.
• Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician's office to provide ongoing case management services.

Required qualifications include:

• Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services required (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 and/or as business needs arise.
• Must have computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.

Preferred qualifications include:

• Case management and discharge planning experience preferred.
• Two years' experience in behavioral health, social services or appropriate related field equivalent to program focus.
• Managed Care experience preferred.
• Effective communication, telephonic and organization skills.
• Excellent analytical and problem-solving skills.
• Ability to work independently.
• Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Anticipated weekly hours: 40

Time type: Full time

Pay range: $21.10 - $44.99

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. 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.