Analyst, Case Management

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.

Thank you for your interest in furthering your career with CVS Health. This is a full‑time telework position open to candidates in the United States. Schedule for this position is Monday - Friday, 8:00a-5:00p in the assigned market time zone. The Case Management Coordinator (i.e. CC) utilizes critical thinking and judgment to collaborate and inform the case management process. The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits 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.

• 2+ years experience in behavioral health or social services.
• Must have the ability to work 8:00a-5:00p in assigned market time zone. (EST/CST Primarily)
• 2+ years of experience with Microsoft Office Applications (Word, Excel, Outlook).

• Case Management and discharge planning experience.
• Managed Care experience.

Bachelor's degree or non‑licensed master level clinician with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling) or equivalent experience.

40

Full time

The Typical Pay Range For This Role Is $21.10 - $49.08. 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.

• Affordable medical plan options,…