Job Description

This Clinical Case Manager BH position is with Aetna’s Long-Term Services and Support (LTSS) team and is a Field Based position out of Peoria and Tazewell IL. An active Illinois Behavioral Health License is required (LCSW/LCPC). Travel: 50-75% required in Peoria and Tazewell Counties and surrounding areas. As a Clinical Case Manager you will facilitate appropriate healthcare outcomes for our 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 knowledgeably 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: Minimum of 2 years of experience in behavioral health, social services or Human services field. Active IL BH clinical license: LCSW, LCPC. Must live in Peoria or Tazewell IL or surrounding areas. Must possess reliable transportation and be willing and able to travel up to 50-75% of the time to meet with members face to face in Peoria and Tazewell and surrounding areas. Mileage is reimbursed per our company expense reimbursement policy. Preferred Qualifications: Case management and discharge planning experience. Managed Care experience. Microsoft Office experience. Education: Master's Degree required.

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