Case Management Coordinator

Job DescriptionAetna Better Health is hiring for multiple openings across the state/regions of Kentucky. The Population Health/Wellness 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 5-10% of the time. Travel is with a personal vehicle. Qualified candidates must have valid KY driver's license, proof of vehicle insurance, and reliable transportation. Travel to the Louisville office for meetings and training is also anticipated. This position is assigned to the Southern Bluegrass Region (Boyle, Clark, Estill, Fayette, Garrard, Jessamine, Clark, Lincoln Madison, Mercer and Powell). Qualified candidates may reside in or adjacent to the assigned region. 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- 6+ months experience and detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the Kentucky SKY populations, is required.- 1+ year(s) experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.- 1+ year(s) computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.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 experience preferred. - Managed Care experience preferred. - 6+ months Knowledge of growth and appropriate developmental milestones strongly preferred.EducationMinimum of a Bachelor's degree required or a non-licensed master level clinician is preferred with either degree being in behavioral health or human services field.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-06-14