Case Management Coordinator-Lake County IL

Job DescriptionQualifying candidates may be eligible for up to a $3000 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 itpossible 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 Servicesstrategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage andpolicies.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 andeducation for members through the use of care management tools and resources.Evaluation of Members: -Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member'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 andservice 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 health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order toachieve 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 benefitsand/or healthcare needs. - Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. -Providescoaching, 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 inhealthcare decision-making. Monitoring, Evaluation and Documentation of Care: - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and companypolicies and procedures.Required Qualifications- 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus- Must be willing to travel up to 50 - 75% in Lake County ILCOVID 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 experience preferred- Managed Care experience preferredEducationAssociates degree requiredBusiness 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: 2025-10-04