Analyst ,Case Management Must live in Cumberland, KY

About the position Aetna Better Health is seeking a dedicated Case Management Coordinator (CMC) for the Cumberland region. This role is pivotal in utilizing critical thinking and professional judgment to support the case management process, ultimately aiming to enhance healthcare outcomes for members. The CMC will provide advocacy, collaboration, coordination, support, and education for members through the effective use of care management tools and resources. This position is fully remote, but candidates must reside in specific counties within the Cumberland region of Kentucky, including Green, Taylor, Adair, Cumberland, Clinton, Russell, Casey, Pulaski, Wayne, McCreary, Rockcastle, Jackson, Laurel, Whitley, Knox, Clay, Bell, or Harlan counties. The CMC will be responsible for evaluating members through care management assessments and data reviews, recommending approaches to resolve care needs, and maintaining optimal health and well-being. This includes identifying high-risk factors and service needs that may impact member outcomes and implementing proactive support interventions. The role also involves coordinating and implementing wellness care plan activities while monitoring member care needs. In addition to enhancing medical appropriateness and quality of care, the CMC will consult with case managers, supervisors, and Medical Directors to overcome barriers to achieving goals. They will identify and escalate quality of care issues, utilize negotiation skills to secure necessary services, and employ motivational interviewing techniques to engage members effectively. The CMC will provide coaching and support to empower members to make informed healthcare decisions and participate actively in their care. Monitoring, evaluation, and documentation of care are also critical components of this role, ensuring compliance with regulatory and accreditation guidelines as well as company policies and procedures. The CMC must be flexible to work beyond core business hours, as the needs of children and families may require after-hours support.

Responsibilities

• Utilize care management assessments and data review to recommend approaches for resolving care needs.

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• Identify high-risk factors and service needs impacting member outcomes and implement proactive support interventions.

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• Coordinate and implement wellness care plan activities and monitor member care needs.

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• Consult with case managers, supervisors, and Medical Directors to overcome barriers to meeting goals.

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• Identify and escalate quality of care issues through established channels.

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• Utilize negotiation skills to secure appropriate options and services for members.

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• Employ motivational interviewing skills to ensure maximum member engagement and promote healthy lifestyle changes.

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• Provide coaching and support to empower members in making independent medical choices.

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• Help members actively participate in healthcare decision-making.

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• Utilize case management and quality management processes in compliance with regulatory guidelines.

Requirements

• Must reside in the Cumberland region of Kentucky (specific counties listed).

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• Ability to travel up to 5% of the time.

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• Minimum 6 months experience in Foster Care, juvenile justice systems, Adoption Assistance, or related fields.

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• Minimum 1 year of experience in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.

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• Minimum 1 year of experience in MS Office Suite applications, including Word and Excel.

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• Bachelor's degree or non-licensed master level clinician in behavioral health or human services field.

Nice-to-haves

Benefits

• Medical, dental, and vision benefits.

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• 401(k) retirement savings plan.

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• Employee Stock Purchase Plan.

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• Fully-paid term life insurance plan.

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• Short-term and long-term disability benefits.

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• Well-being programs and education assistance.

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• Free development courses.

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• CVS store discount and discount programs with partners.

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• Paid Time Off (PTO) and paid holidays.

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