Case Management Analyst - Field in Danville, VA

CVSHealth; Danville (VA); On-site; USD 65,000 - 90,000; Full time

Job summary

CVS Health's Aetna LTSS team seeks a field-based Analyst, Case Management to support members in Danville, VA. This role requires travel about 70% to meet with members face to face and coordinate care across plans and programs.

You will evaluate member needs, develop and monitor care plans, and collaborate with clinical staff to ensure safe, effective and affordable care outcomes for diverse populations in the community.

Responsibilities

• Utilizes critical thinking and judgment to collaborate and inform the case management process to facilitate appropriate healthcare outcomes for members by providing care coordination, support, and education for members using care management tools and resources.
• Uses care management tools and information to evaluate members, conducts comprehensive evaluation of 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 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 care plan activities and monitors care plan progress.
• 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 to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

This Analyst, Case Management position is with Aetna's Long-Term Services and Supports (LTSS) team and is a field-based position out of Danville, Virginia Region. The requirements is for candidates to travel 70% of the time to meet with members face to face.

- Utilizes critical thinking and judgment to collaborate and inform the case management process to facilitate appropriate healthcare outcomes for members by providing care coordination, support, and education for members using care management tools and resources.

-Uses care management tools and information to evaluate members, conducts comprehensive evaluation of 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 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 care plan activities and monitors care plan progress.

-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 to achieve optimal outcomes.

-Identifies and escalates quality of care issues through established channels.

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