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Support Aetna members with complex healthcare and social needs across Illinois. Assess care needs, coordinate services, and help improve health outcomes.
विवरण
- Assess member needs and eligibility through care management tools, available information, and data review.
- Evaluate benefit plans, programs, and services to recommend solutions that address member needs and resolve cases.
- Recognize high-risk factors and service requirements, referring members to clinical case management or crisis intervention when appropriate.
- Coordinate assigned care plan activities and track progress toward planned goals.
- Work with case managers, supervisors, Medical Directors, and other health programs to address barriers to care objectives.
- Present cases during multidisciplinary conferences to support comprehensive review and optimal outcomes.
- Identify quality-of-care concerns and escalate them through established processes.
- Negotiate suitable benefit and healthcare service options based on members' needs.
- Apply influencing and motivational interviewing techniques to engage members and encourage lifestyle and behavior changes.
- Offer coaching, information, and support that enable independent healthcare and healthy lifestyle decisions.
- Participate in team meetings and contribute to peer mentoring and training.
- Help members engage knowledgeably with providers in healthcare decisions.
- Apply case and quality management procedures in accordance with regulatory, accreditation, and company standards.
- Support members with appointment scheduling, benefit access, and health education.
आवश्यकताएँ
- Two years of experience in behavioral health, social services, or a related field aligned with the program focus.
- Confidence working independently from home and collaborating with teams through virtual tools.
- Ability to travel within an assigned geographic area for in-person case management activities as directed by leadership or business needs.
- Strong analytical and problem-solving capabilities.
- Effective communication, organization, and interpersonal skills.
- Ability to work independently.
- Proficiency with standard corporate software, including Microsoft Word, Excel, Outlook, PowerPoint, and selected proprietary applications.
- Efficient computer skills, including navigation across multiple systems and keyboarding.
- Bachelor's degree or a non-licensed master's-level clinician qualification in behavioral health or human services, such as psychology, social work, marriage and family therapy, or counseling.
- Case management and discharge planning experience preferred.
- Managed care experience preferred.
लाभ
- Eligibility for a CVS Health bonus, commission, or short-term incentive program in addition to base pay.
- Medical coverage.
- Dental coverage.
- Vision coverage.
- Paid time off.
- Retirement savings options.
- Wellness programs.
- Resources supporting physical, emotional, and financial well-being.
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