Analyst, Case Management Field

CVS Health•Glen Allen, VA

21h•$21 - $41

About The Position

The Analyst, Case Management Field collaborates in the case management process to support appropriate healthcare outcomes for members through care coordination, support, and education. The role evaluates members’ needs and eligibility, reviews benefit plans and available programs and services, identifies risks and service needs, and recommends approaches to resolving cases or meeting member needs. It coordinates and monitors care plan activities, helps address barriers to care, and refers members to clinical case management or crisis intervention when appropriate. The position works with case managers, supervisors, Medical Directors, and other health programs, including presenting cases for multidisciplinary review. It identifies and escalates quality-of-care issues, negotiates appropriate services, and uses motivational interviewing, coaching, and education to encourage member engagement and support informed healthcare and lifestyle decisions. Case management and quality management processes must be followed in accordance with regulatory and accreditation guidelines and company policies and procedures. This role is for candidates residing in Central Virginia and requires up to 70% travel within the Central Virginia region.

Requirements

At least 2 years of experience in behavioral health, social services, or an appropriate related field equivalent to the program focus.
Must reside in the Central Virginia area.
Up to 70% travel in the Central Virginia region is required.
A bachelor's degree or a non-licensed master's-level clinician qualification is required.

Nice To Haves

A degree in behavioral health or human services, such as psychology, social work, marriage and family therapy, or counseling.
Case management and discharge planning experience.
Managed care experience.

Responsibilities

Use critical thinking and judgment to collaborate in the case management process and facilitate appropriate healthcare outcomes through care coordination, support, and education.
Evaluate members’ needs and eligibility using care management tools and information, and recommend approaches to case resolution or meeting needs based on benefit plans and available programs and services.
Identify risk factors and service needs that may affect member outcomes and care planning, and refer members to clinical case management or crisis intervention when appropriate.
Coordinate and implement assigned care plan activities and monitor care plan progress.
Consult with case managers, supervisors, Medical Directors, and other health programs to address barriers to goals and objectives, and present cases for multidisciplinary review.
Identify and escalate quality-of-care issues through established channels.
Negotiate appropriate options and services to meet members’ benefit and healthcare needs.
Use motivational interviewing to promote member engagement and lifestyle or behavior changes.
Coach, inform, and support members in making independent medical and healthy-lifestyle choices.
Help members participate knowledgeably with their providers in healthcare decision-making.
Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.