Case Management Coordinator - Field - Northeastern Region, KY

Position Summary Aetna Better Health is hiring for multiple openings across the state of Kentucky. The Case Management Coordinator (CMC) utilizes critical thinking and professional judgment to support the case management process, facilitating improved healthcare outcomes for members through advocacy, collaboration, coordination, support, and education using care management tools. This telework position requires 80‑90% regional in‑state travel and time in the Northeastern Region (Bath, Boyd, Bracken, Carter, Elliott, Fleming, Greenup, Lawrence, Lewis, Mason, Menifee, Montgomery, Morgan, Robertson, Rowan). Qualified candidates must reside in one of the assigned counties and have reliable transportation. Work hours are Monday‑Friday 8 a.m.–5 p.m. EST with flexibility for after‑school or after‑work appointments. Evaluation of Members Use care management assessments and data review to recommend approaches to resolve care needs, maintaining optimal health and well‑being by evaluating members’ benefit plans and available internal and external programs/services. Identify high‑risk factors and service needs that may impact member outcomes and implement early and proactive support interventions. Coordinate and implement wellness care plan activities and monitor member care needs. Enhancement of Medical Appropriateness and Quality of Care Consult with case managers, supervisors, medical directors, and other health programs to overcome barriers, presenting cases at conferences for multidisciplinary review. Identify and elevate quality of care issues through established channels. Use negotiation skills to secure appropriate options and services to meet members’ benefits and healthcare needs. Employ influencing/motivational interviewing skills to ensure member engagement and promote lifestyle/behavior changes. Provide coaching, information, and support to empower members to make independent medical and healthy lifestyle choices. Help members actively and knowingly participate with their provider in healthcare decision‑making. Monitoring, Evaluation and Documentation of Care Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Required Qualifications Minimum 6 months experience in foster care and juvenile justice systems, adoption assistance, behavioral health services, trauma‑informed care, ACEs, crisis intervention services, or evidence‑based practices applicable to Kentucky SKY populations. Minimum 2 years of experience in behavioral health, social services, social work, psychology, sociology, marriage‑and‑family therapy, or counseling. Minimum 1 year of experience with MS Office Suite applications, including Word and Excel. Willing and able to travel 80‑90% of the time within the assigned region. Candidate must reside in one of the following counties: Bath, Boyd, Bracken, Carter, Elliott, Fleming, Greenup, Lawrence, Lewis, Mason, Menifee, Montgomery, Morgan, Robertson, Rowan. Preferred Qualifications 3+ years of experience in behavioral health, social services, social work, psychology, sociology, marriage‑and‑family therapy, or counseling. 1+ MCO experience. Education Minimum of a Bachelor’s degree or a non‑licensed master’s level clinician in behavioral health or a relevant human services field (social work, psychology, marriage‑and‑family therapy, counseling). Work Details Anticipated weekly hours: 40. Time type: Full time. Pay Range The typical pay range for this role is $21.10 – $36.78 per hour. The final base salary will depend on experience, education, location, 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. Benefits Eligible for a comprehensive benefits package supporting physical, emotional, and financial well‑being, including 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