Case Management Analyst- Field

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• Job DescriptionA Brief Overview
  Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members. Helps implement projects, programs, and processes for Case Management. Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area.
  
  What you will do
  • Consults with case managers, supervisors, medical directors and/or other health programs using a holistic approach, to overcome barriers to meeting goals and objectives.
  • Presents cases at case conferences to obtain a multidisciplinary review in order to achieve optimal outcomes.
  • Identifies and escalates quality of care issues through established channels.
  • Demonstrates negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
  • Delivers 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.
  • Assists in encouraging members to actively participate with their provider in healthcare decision-making.
  • Conducts comprehensive evaluations of referred members’ needs/eligibility using care management tools and recommends an approach to case resolution.
  
  For this role you will need Minimum Requirements
  • Demonstrated attention to detail.
  • Ability to travel up to 50% of time.
  • Ability to interface with customers/clients.
  • 0-2 years work experience
  
  Education: Bachelor degree

• 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 Northern Bluegrass Region (Boone, Bourbon, Campbell, Carroll, Gallatin, Grant, Harrison, Kenton, Nichols, Owen, Pendleton, and Scott).

  Qualified candidates must reside in a county in the assigned region.

  Schedule-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.