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Case Management Coord (Champaign/Bloomington)

Company: CVS Health
Location: downers grove
Posted on: May 3, 2021

Job Description:

Job Description

Utilizes critical thinking and judgment to collaborate and inform the case management process, in order 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.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 in order 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


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)

Preferred Qualifications

Case management and discharge planning experience

preferred Managed Care experience preferred

Microsoft Office experience preferred

LCSW / LCPC/ LPC / LMFT / LPN / RN preferred.


Bachelor or master's degree prepared in human-services

related field

One (1) year of satisfactory program experience may

replace one year of college education, at least four (4)

years of experience replacing baccalaureate degree

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: CVS Health, Downers Grove , Case Management Coord (Champaign/Bloomington), Other , downers grove, Illinois

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