Case Management Analyst – Field (Must live in Cumberland Region, KY)

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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 telework 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. This position is assigned to the Cumberland Service Region (Green, Taylor, Adair, Casey, Russell, Cumberland, Clinton, Wayne, Pulaski, McCreary, Whitley, Laurel, Rockcastle, Jackson, Clay, Knox, Bell, and Harlan counties). Qualified candidates must reside in a 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 member’s 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 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 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: Green, Taylor, Adair, Casey, Russell, Cumberland, Clinton, Wayne, Pulaski, McCreary, Whitley, Laurel, Rockcastle, Jackson, Clay, Knox, Bell, or Harlan County.

Preferred Qualifications
3+ years' experience required in behavioral health, social services, social work, psychology, sociology, marriage and