CVS Health Case Management Coordinator - Champaign IL in Downers Grove, Illinois
Utilizes critical thinking and judgment to collaborate and inform 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 optimal outcomes. - 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.
-2 years experience in behavioral health, social services or human services field.- Must be willing and able to travel using your own vehicle 50-75% of their time to meet members face to face in Champaign, IL and surrounding areas.-Valid Driver's License Required.
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.
If you are 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 within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
- Case management and discharge planning experience - Managed Care experience preferred- Microsoft Office experience preferred
Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling).
At 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.