Case Manager - Healthcare Consultant I - La Salle/Bureau County IL

Enhancement of Medical Appropriateness and Quality of Care: o 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. • Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members' needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members' benefit plan and available internal aid and external programs/services.

Job ID: 26-129285
Job Title: ‘Healthcare Consultant I - La Salle/Bureau County IL’
Position Type: Contract Role
Location: Springfield, IL 62701
Work Type: Travel up to 75% of their time to meet with members face to face
Est. Pay Range: $30.00/Hour to $34.14/Hour on W2 (USD)
Schedule: Monday-Friday 8am-5pm
 
Must reside in the state of Illinois in LaSalle/Bureau County area
• Valid Illinois Driver’s license
• Willing and able to travel up to 75% of their time to meet with members face to face
• Reliable Transportation required, eligible for mileage reimbursement as per company policy.
• Minimum of two (2) years of case management experience
• Microsoft Office and electronic health record experience
 

• This Analyst, Case Management Field position is with Aetna’s Long-Term Services & Supports (LTSS) team and is a field-based position out of the xxxx area of Illinois.  The requirements is for candidates to travel 50-75% of the time to meet with members face to face.
• This position holds a full caseload to manage waiver members.
• This position requires in person quarterly visits with members.
• This position is critical to meet contractual requirements.
• Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources.

 
Duties:
Evaluation of Members:
 
• Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members' needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members' benefit plan and available internal aid and external programs/services.
o 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.
o Coordinates and implements assigned care plan activities and monitors care plan progress.
 
• Enhancement of Medical Appropriateness and Quality of Care:
o 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.
o Identifies and escalates quality of care issues through established channels.
o Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
o Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
o Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
o Helps member actively and knowledgeably participate with their provider in healthcare decision-making.
 
• Monitoring, Evaluation and Documentation of Care:
o Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
 
Experience:
Must reside in the state of Illinois in LaSalle/Bureau County area
• Valid Illinois Driver’s license
• Willing and able to travel up to 75% of their time to meet with members face to face
• Reliable Transportation required, eligible for mileage reimbursement as per company policy.
• Minimum of two (2) years of case management experience
• Microsoft Office and electronic health record experience
 
Position Summary:

• This Analyst, Case Management Field position is with Aetna’s Long-Term Services & Supports (LTSS) team and is a field-based position out of the LaSalle/Bureau County area of Illinois.
• The requirements is for candidates to travel 50-75% of the time to meet with members face to face.
• This position holds a full caseload to manage waiver members.
• This position requires in person quarterly visits with members.
• This position is critical to meet contractual requirements.
• Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources.

 
Education:
Individual with a bachelor’s degree or a non-licensed individual with a master’s degree, with either degree being in a human-services field (including, but not limited to sociology, special education, rehabilitation counseling)