Analyst Case Management, Field - Must live in Louisiana

CVS Health•Hammond, LA

3d•$21 - $37•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Case Management Coordinator (CMC) utilizes critical thinking and judgment to collaborate and inform the case management process, to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. This position is in the ABH- Louisiana Care Management Program. Schedule is Monday-Friday standard business hours 8 AM- 5 PM. No nights, no weekends, and no holidays. Must live in Region 1 - Orleans, Jefferson, St. Bernard, Plaquemines or Region 4 Evangeline, St. Landry, Acadia, Lafayette, St. Martin, Iberia, Vermillion Evaluation of Members: Using 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 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 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.

Requirements

2+ years' experience in behavioral health, social services or appropriate related field equivalent to program focus.
2+ years' experience with adult and/or adolescent populations.
Must reside in Louisiana
Must have reliable transportation and be willing and able to travel 50% of the time or more.
Demonstrated proficiency with personal computer, keyboard navigation, and mouse
Familiarity and proficiency with MS Office Suite applications including MS Teams, Outlook, Word, Excel, and SharePoint.

Nice To Haves

Medicaid experience.
Waiver experience
Crisis intervention skills
Managed care/utilization review experience
Familiarity with QuickBase
Case management and discharge planning experience

Responsibilities

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.
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 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 knowledgably participate with their provider in healthcare decision-making.
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.