Job Description

This Analyst, Case Management position is with Aetna’s Long-Term Services and Supports (LTSS) team and is a field-based position out of Roanoke Virginia Region. The requirements is for candidates to travel 70% of the time to meet with members face to face. 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 using care management tools and resources. Uses care management tools and information to evaluate members, conducts comprehensive evaluation of 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 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 healthcare needs. Utilizes 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 members to make ongoing independent medical and/or healthy lifestyle choices. Helps members 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. Must reside in Martinsville Virginia or Surround Areas. Must possess reliable transportation and be willing and able to travel up to 70% of the time. Mileage is reimbursed per company expense reimbursement policy. Preferred Qualifications: Case management and discharge planning experience preferred. Managed Care experience preferred. 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). Certification in LMHP, RN/LPN, QMHP, LMSW, LBSW, MSW or BSW preferred.

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