Intensive Case Management Analyst- Field- Must reside in Jefferson County

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Position Summary

Aetna Better Health is hiring for multiple openings across the state/regions of Kentucky. Case Management Coordinator (CMC) utilizes critical thinking and professional judgment to support the case management process in order to facilitate and maintain improved healthcare outcomes for members by providing advocacy collaboration coordination support and education for members through the use of care management tools and resources.

This is a Field position that requires regional in-state travel 80-90% of the time. Qualified candidate must have reliable transportation. Travel to the Louisville office for meetings and training is also anticipated. Travel to members homes schools hospitals doctors offices DCBS offices etc. is expected for member face to face time. This position is assigned to the Jefferson Region Jefferson County. Qualified candidates must reside in Jefferson county in the assigned region. Flexibility to work beyond core business hours of Monday-Friday 8am-5pm EST is required. We are serving the needs of children and families that may require working after school after work etc.

Evaluation of Members:

- Through the use of care management assessments and information/data review recommends an approach to resolving care needs maintaining optimal health and well-being by evaluating members benefit plan and available internal and external programs/services.

- Identifies high risk factors and service needs that may impact member outcomes and implements early and proactive support interventions.

- Coordinates and implements Wellness care plan activities and monitors member care needs.

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 members 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 knowledgably 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 6 months experience in Foster Care and juvenile justice systems Adoption Assistance the delivery of Behavioral Health Services Trauma-informed Care ACEs Crisis Intervention services or evidence-based practices applicable to the Kentucky SKY populations is required.

-Minimum 2 year of experience required in behavioral health social services social work psychology sociology marriage and family therapy or counseling.

- Minimum 1 year of experience in MS Office Suite applications including Word and Excel.

-Willing and able to travel 80-90% of their time to meet members face to face in their assigned region.

-Candidate must reside in one of the following counties: Jefferson County

Preferred Experience

- 3 years experience in behavioral health social services social work psychology sociology marriage and family therapy or counseling.

- 1 years of MCO experience.

Education

Minimum of a Bachelors or Masters degree or a non-licensed master level clinician is required; with either degree being in behavioral health or a relevant human services field of study required (social work psychology marriage and family therapy counseling).

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.