Analyst, Case Management - Field

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Position Summary

The Aetna Better Health of West Virginia plan has a successful, 26+ year history of partnering with the State to provide West Virginia’s Medicaid population with top notch health care coordination and service.

The plan also has been chosen to provide care coordination to complex foster care children of the state. Through a strong, localized team, an innovative care management model, and creative provider and community advocacy partnerships, Aetna Better Health of West Virginia has successfully assisted the State in achieving high quality standards and outcomes for the Medicaid population across the state.

The health plan truly embodies the commitment of West Virginian’s helping West Virginian’s. At Aetna Better Health of West Virginia, you can be the very best you can be working with strong teams committed to helping our members and with opportunities for career growth.

We will support you all the way!

This is a full-time field teleworker position that requires West Virginia residency. Travel is required 50% of the time or more, in the Southern region of WV.

Field based travel locations may include member homes, residential treatment facilities, group homes, shelters, and detention facilities.

Qualified candidates must reside in the region, in one of the following counties : Mingo, Logan, Boone, McDowell, Wyoming, Raleigh, Mercer, Summers, Monroe, Greenbrier, Pocahontas.

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 through the use of care management tools and resources.

Schedule is Monday-Friday standard business hours. No nights, no weekends, and no holidays.

Evaluation of Members :

Through the use of care management tools and information / data review, conducts 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.

Identifies 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.

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.

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

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

West Virginia resident residing in one of the following counties : Mingo, Logan, Boone, McDowell, Wyoming, Raleigh, Mercer, Summers, Monroe, Greenbrier, Pocahontas.

Must possess reliable transportation and be willing and able to travel in the assigned region 50% or more of the time. Mileage is reimbursed per our company expense reimbursement policy.

2+ years of experience with personal computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams)

Preferred Qualifications

Medicaid experience.

Waiver experience

Foster care experience

Crisis intervention skills

Managed care / utilization review experience

Case management and discharge planning experience

Familiarity with QuickBase

Education

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).

Pay Range

The typical pay range for this role is :

$19.52 - $36.78

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.

The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.

The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.

The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits.

CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.

As for time off, Company employees enjoy Paid Time Off ( PTO ) or vacation pay, as well as paid holidays throughout the calendar year.

Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.