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Case Management Coordinator - Skokie and Niles, IL

Company: Aetna Inc.
Location: Des Plaines
Posted on: May 3, 2021

Job Description:

Job Description

As a Case Management Coordinator you will utilize critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for our members by providing care coordination, support and education for members through the use of care management tools and resources.

Travel: 50-75% in North Cook County including Skokie and Niles, IL and surrounding areas.

Additional responsibilities of the Case Management Coordinator include:

* Using care management tools and information/data to conduct 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.
* Identifying high 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.
* Coordinating and implementing assigned care plan activities and monitoring care plan progress.
* 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.
* Identifying and escalating quality of care issues through established channels.
* Utilizing negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
* Influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
* Coaching and supporting to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
* Helping member actively and knowledgeably participate with their provider in healthcare decision-making.
* Utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

* 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus


* Must be comfortable completing field based travel to meet with members; 50-75% Travel required in North Cook County (Skokie and Niles City) and surrounding areas

Preferred Qualifications

* Case management and discharge planning experience
* Managed Care experience
* Microsoft Office experience
* Active and Unrestricted state licensure preferred (LCSW / LCPC/ LPC / LMFT / LPN / RN)


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)

Business Overview

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.

Keywords: Aetna Inc., Des Plaines , Case Management Coordinator - Skokie and Niles, IL, Other , Des Plaines, Illinois

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