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• Job Description
  A 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.

  - 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.
  
  Preferred Qualifications

  3+ years' experience required 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 level clinician is required with either degree being in behavioral health or human services field.

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health

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