Case Management Analyst- Field

Hispanic Alliance for Career Enhancement; McLean (VA); On-site; USD 80,000 - 100,000; Full time

Job summary

A leading health solutions company is seeking a Case Management Coordinator to enhance healthcare outcomes for members through advocacy and coordination. This full-time telework position requires significant travel within the assigned region and offers a comprehensive benefits package. Ideal candidates will have experience in behavioral health and a relevant degree.

Benefits

Comprehensive health plans

401(k) plan

Stock purchase plan

Wellness programs

Paid time off

Flexible schedules

Qualifications

• Minimum 6 months experience in Foster Care, juvenile justice, or related fields.
• Minimum 2 years experience in behavioral health or social services.
• Willingness to travel 80-90% within the assigned region.

Responsibilities

• Support case management process to improve healthcare outcomes.
• Coordinate and monitor wellness care plan activities.
• Consult with case managers and medical directors.

Skills

Critical thinking

Collaboration

Crisis Intervention

Motivational interviewing

Education

Bachelor’s degree in behavioral health or human services

Tools

MS Office

Job description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues—caring for people where, when, and how they choose in a way that is more connected, convenient, and compassionate. We do it all with heart, each and every day.

Position Summary

Aetna Better Health is hiring multiple positions across Kentucky. The Case Management Coordinator (CMC) uses critical thinking and professional judgment to support the case management process, aiming to improve healthcare outcomes for members by providing advocacy, collaboration, coordination, support, and education through care management tools and resources.

This is a telework position requiring regional in-state travel 80-90% of the time. Candidates must have reliable transportation. Travel to the Louisville office for meetings and training is also expected. The position covers the Cumberland Service Region (specific counties listed). Candidates must reside in one of these counties and have flexibility to work beyond standard hours, including after school and after work, to serve children and families.

Evaluation of Members

1. Use care management assessments and data review to recommend approaches for resolving care needs, maintaining health and well-being, and evaluating member benefit plans and available services.
2. Identify high-risk factors and service needs impacting outcomes; implement early, proactive interventions.
3. Coordinate and monitor wellness care plan activities and member care needs.

Enhancement of Medical Appropriateness and Quality of Care

1. Consult with case managers, supervisors, Medical Directors, and other health programs to address barriers and achieve optimal outcomes; present cases at conferences for multidisciplinary review.
2. Identify and escalate quality of care issues through established channels.
3. Negotiate to secure appropriate options and services to meet healthcare needs.
4. Use motivational interviewing to maximize member engagement and promote healthy lifestyle changes.
5. Provide coaching, information, and support for members to make informed medical and lifestyle decisions.
6. Encourage active participation of members with providers in healthcare decisions.

Monitoring, Evaluation, and Documentation of Care

Utilize case and quality management processes in compliance with regulatory, accreditation, and company policies.

Required Qualifications

• Minimum 6 months experience in Foster Care, juvenile justice, Adoption Assistance, Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention, or related fields applicable to Kentucky SKY populations.
• Minimum 2 years experience in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
• At least 1 year experience with MS Office applications.
• Willingness and ability to travel 80-90% within the assigned region.
• Reside in one of the specified counties.

Preferred Qualifications

• Over 3 years experience in behavioral health or social services.
• Experience with Managed Care Organizations (MCO).

Education

Bachelor’s degree or non-licensed master’s in behavioral health or human services field.

Additional Details

• 40 hours/week, full-time.
• Pay range: $21.10 - $36.78 per hour or equivalent annual salary, dependent on experience and other factors.
• Comprehensive benefits including health plans, 401(k), stock purchase plan, wellness programs, paid time off, flexible schedules, and more.
• Application deadline: 05/31/2025.