About this opportunity
Oak St. Health lists this Analyst, Case Mgt Field opportunity in springfield, Illinois. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Analyst, Case Management Field
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.
This Analyst, Case Management Field position is with Aetna's Long Term Services & Supports (LTSS) team and is a field-based position out of the Rock Island County area of Illinois. The requirement is for candidates to travel 50-75% of the time to meet with members face to face. This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meet contractual requirements. Facilitate appropriate healthcare outcomes for waiver/LTSS 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 members' needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members' benefit plan and available internal aid 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:
Must reside in the state of Illinois in Rock Island area
Valid Illinois Driver's license
Willing and able to travel up to 75% of their time to meet with members face to face
Reliable Transportation required, eligible for mileage reimbursement as per company policy.
Minimum of two (2) years of case management experience
Microsoft Office and electronic health record experience
NOTE: If position is intended to manage HIV/AIDs HCBS Waiver members, It is mandatory that individuals have experience in working with racial and ethnic minorities, as well as one or more of the following:
domestic abuse;
the lesbian, gay, bisexual, transgender, queer (LBGTQ+) community;
Persons living with HIV/AIDS
Persons with substance use disorders.
Preferred Qualifications:
Case management and discharge planning experience preferred
Managed Care experience preferred
Microsoft Office experience preferred
Education:
Individual with a bachelor's degree or a non-licensed individual with a master's degree, with either degree being in a human-services field (including, but not limited to sociology, special education, rehabilitation 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.
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.
Worksite address
springfield, IL, 62777, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.