Analyst, Case Management Field

CVS Health•Front Royal, VA

20h•$21 - $41•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 -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 using care management tools and resources. -Uses care management tools and information to evaluate members, conducts comprehensive evaluation of 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 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 healthcare needs. -Utilizes 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 members to make ongoing independent medical and/or healthy lifestyle choices. -Helps members 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

Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling), LMHP, RN/LPN, QMHP, LMSW, LBSW, MSW or BSW
2 years’ experience in behavioral health, social services or appropriate related field equivalent to program focus
Up to 70% travel will be required in Central region

Nice To Haves

Case management and discharge planning experience preferred
Managed Care experience preferred

Responsibilities

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 using care management tools and resources.
Uses care management tools and information to evaluate members, conducts comprehensive evaluation of 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 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.
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 healthcare needs.
Utilizes 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 members to make ongoing independent medical and/or healthy lifestyle choices.
Helps members 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.