Case Management Coordinator-Lee County IL
Company: CVS Health
Location: Sterling
Posted on: May 16, 2022
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Job Description:
*Job Description*Qualifying candidates may be eligible for up to
a $3,000 sign on bonus.The dedication of talented and caring health
care professionals drives the delivery of high quality, cost
effective products and services. They make it possible for members
to get the right health care treatment for their needs- and for
Aetna to keep its competitive edge.Develop, implement, support, and
promote Health Services strategies, tactics, policies, and programs
that drive the delivery of quality healthcare to establish
competitive business advantage for Aetna. Health Services
strategies, policies, and programs are comprised of utilization
management, quality management, network management and clinical
coverage and policies.Utilizes critical thinking and judgment to
collaborate and inform the case management process, in order to
facilitate appropriate healthcare outcomes for members by providing
care coordination, support and education for members through the
use of care management tools andresources.Evaluation of Members:
-Through the use of care management tools and information/data
review, conducts comprehensive evaluation of referredmember's
needs/eligibility and recommends an approach to case resolution
and/or meeting needs 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
care planning components with appropriate referral to clinical case
management or crisis intervention as appropriate. - Coordinates and
implements assigned careplan activities and monitors care plan
progress. Enhancement of Medical Appropriateness and Quality of
Care: - Using holistic approach consults withcase managers,
supervisors, Medical Directors and/or other healthprograms to
overcome barriers to meeting goals and objectives-- presentscases
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 secureappropriate 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 promotelifestyle/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. -Helpsmember actively and
knowledgably participate with their provider in healthcare
decision-making. Monitoring, Evaluation and Documentation of Care:
- Utilizes case management and quality management processes
incompliance with regulatory and accreditation guidelines and
company policies and procedures.*Required Qualifications*- 2+
years' experience in behavioral health, social services, or
appropriate related field equivalent to program focus- Active
unrestricted driver's license in IL- Must be willing to travel
50-75% in Lee County IL and surrounding areas once COVID
restrictions have been lifted*COVID Requirements**COVID-19
Vaccination Requirement*CVS Health requires certain colleagues to
be fully vaccinated against COVID-19 (including any booster shots
if required), where allowable under the law, unless they are
approved for a reasonable accommodation based on disability,
medical condition, religious belief, or other legally recognized
reasons that prevents them from being vaccinated. You are required
to have received at least one COVID-19 shot prior to your first day
of employment and to provide proof of your vaccination status or
apply for a reasonable accommodation within the first 10 days of
your employment. Please note that in some states and roles, you may
be required to provide proof of full vaccination or an approved
reasonable accommodation before you can begin to actively
work.*Preferred Qualifications*- Case management and discharge
planning experience preferred- Managed Care experience
preferred*Education*Bachelor's degree or non-licensed master level
clinician required, with either degree being in behavioral health
or human services preferred (psychology, social work, marriage and
family therapy, counseling).*Business Overview*At Aetna, a CVS
Health company, we are joined in a common purpose: helping people
on their path to better health. We are working to transform health
care through innovations that make quality care more accessible,
easier to use, less expensive and patient-focused. Working together
and organizing around the individual, we are pioneering a new
approach to total health that puts people at the heart.We are
committed to maintaining a diverse and inclusive workplace. CVS
Health is an equal opportunity and affirmative action employer. We
do not discriminate in recruiting, hiring or promotion based on
race, ethnicity, gender, gender identity, age, disability or
protected veteran status. We proudly support and encourage people
with military experience (active, veterans, reservists and National
Guard) as well as military spouses to apply for CVS Health job
opportunities.
Keywords: CVS Health, Rockford , Case Management Coordinator-Lee County IL, Executive , Sterling, Illinois
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