Case Management Coordinator - Chicago Area, IL

Job DescriptionUtilizes critical thinking and judgment to collaborate andinform the case management process, in order to facilitateappropriate healthcare outcomes for members byproviding care coordination, support and education formembers through the use of care management tools andresources.Evaluation of Members: -Through the use ofcare management tools and information/data review,conducts comprehensive evaluation of referred member'sneeds/eligibility and recommends an approach to caseresolution and/or meeting needs by evaluating member'sbenefit plan and available internal and externalprograms/services. Identifies high risk factors and serviceneeds that may impact member outcomes and careplanning components with appropriate referral to clinicalcase management or crisis intervention as appropriate. -Coordinates and implements assigned care plan activitiesand monitors care plan progress. Enhancement of MedicalAppropriateness and Quality of Care: - Using holisticapproach consults with case managers, supervisors,Medical Directors and/or other health programs toovercome barriers to meeting goals and objectives;presents cases at case conferences to obtainmultidisciplinary review in order to achieve optimaloutcomes. - Identifies and escalates quality of care issuesthrough established channels. -Utilizes negotiation skills tosecure appropriate options and services necessary tomeet the member's benefits and/or healthcare needs. -Utilizes influencing/ motivational interviewing skills toensure maximum member engagement and promotelifestyle/behavior changes to achieve optimum level ofhealth. -Provides coaching, information and support toempower the member to make ongoing independentmedical and/or healthy lifestyle choices. -Helps memberactively and knowledgably participate with their provider inhealthcare decision-making. Monitoring, Evaluation andDocumentation of Care: - Utilizes case management andquality management processes in compliance withregulatory and accreditation guidelines and companypolicies and procedures.Required Qualifications-Minimum of 2 years of experience in behavioral health or social services field.-Willing and able to travel using your own vehicle 50-75% of their time to meet with members face to face in Chicago area, IL (Cook County) and surrounding areas.-Valid Drivers License required.COVID RequirementsCOVID-19 Vaccination RequirementCVS 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 experiencepreferred-Managed Care experience preferred-Microsoft Office experience preferredEducationBachelor's degree or non-licensed master level clinicianrequired, with either degree being in behavioral health orhuman services preferred (psychology, social work,marriage and family therapy, counseling)Business OverviewAt 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.

Created: 2025-11-15