Job Details

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Aetna Better Health is hiring for multiple openings across the state/regions of Kentucky. Case Management Coordinator (CMC) utilizes critical thinking and professional judgment to support the case management process, in order to facilitate and maintain improved healthcare outcomes for members by providing advocacy, collaboration coordination, support and education for members through the use of care management tools and resources.

This is a telework position that requires regional in-state travel 80-90% of the time. Qualified candidate must have reliable transportation. Travel to the Louisville office for meetings and training is also anticipated. This position is assigned to the Salt River Trail Region (Counties: Breckinridge, Grayson, Meade, Hardin, Larue, Bullitt, Nelson, Marion, Washington, Spencer, Anderson, Woodford, Shelby, Franklin, Henry, Oldham, Trimble). Qualified candidates must reside in a county in the assigned region. Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm EST, is required. We are serving the needs of children and families that may require working after school, after work, etc.

Evaluation of Members:

1. Through the use of care management assessments and information/data review, recommends an approach to resolving care needs maintaining optimal health and well-being by evaluating member's benefit plan and available internal and external programs/services.
2. Identifies high risk factors and service needs that may impact member outcomes and implements early and proactive support interventions.
3. Coordinates and implements Wellness care plan activities and monitors member care needs.

Enhancement of Medical Appropriateness and Quality of Care:

1. 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.
2. Identifies and escalates quality of care issues through established channels.
3. Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
4. Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
5. Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
6. 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:

1. Minimum 6 months experience in Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services or evidence-based practices applicable to the Kentucky SKY populations, is required.
2. Minimum 2 year of experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
3. Minimum 1 year of experience in MS Office Suite applications, including Word and Excel.
4. Willing and able to travel 80-90% of their time to meet members face to face in their assigned region.
5. Candidate must reside in one of the following counties: Breckinridge, Grayson, Meade, Hardin, Larue, Bullitt, Nelson, Marion, Washington, Spencer, Anderson, Woodford, Shelby, Franklin, Henry, Oldham, or Trimble.

Preferred Qualifications:

1. 3+ years' experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
2. 1+ MCO experience.

Education:

Minimum of a Bachelor's degree or a non-licensed master level clinician is required with either degree being in behavioral health or human services field.

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range:

The typical pay range for this role is: $21.10 - $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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people:

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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We anticipate the application window for this opening will close on: 06/30/2025.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.