Analyst, Case Management Field

CVS Health • Richmond, VA

2d

About The Position

This position is for candidates residing in Central Virginia and requires up to 70% travel within the Central region. The Analyst, Case Management Field uses critical thinking and judgment to collaborate in the case management process and help facilitate appropriate healthcare outcomes for members through care coordination, support, and education using care management tools and resources.

The role evaluates members’ needs and eligibility, reviews benefit plans and available programs and services, identifies risk factors and service needs that may affect outcomes, and recommends case-resolution approaches. It coordinates assigned care-plan activities, monitors progress, and refers members to clinical case management or crisis intervention when appropriate. The Analyst works with case managers, supervisors, Medical Directors, and other health programs to address barriers, participates in case conferences, escalates quality-of-care concerns, and uses negotiation and motivational interviewing to support members’ healthcare and lifestyle goals. The role also helps members participate knowledgeably in healthcare decisions and follows case-management and quality-management processes in compliance with regulatory, accreditation, and company requirements.

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.
• Bachelor’s degree or non-licensed master-level clinician required.

Nice To Haves

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

Responsibilities

• Collaborate in the case management process to facilitate appropriate healthcare outcomes through care coordination, support, and education.
• Evaluate members’ needs and eligibility using care management tools and information.
• Review members’ benefit plans and available internal and external programs or services to recommend case-resolution approaches.
• Identify risk factors and service needs that may affect member outcomes and care plans, 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 care-plan goals and objectives.
• Present cases at case conferences to obtain multidisciplinary review and support optimal outcomes.
• Identify and escalate quality-of-care issues through established channels.
• Negotiate appropriate options and services to meet members’ benefits and healthcare needs.
• Use motivational interviewing to encourage member engagement and promote lifestyle or behavior changes.
• Coach, inform, and support members in making independent medical and healthy-lifestyle choices.
• Help members participate actively and knowledgeably with providers in healthcare decision-making.
• Use case-management and quality-management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility
• Eligible for a CVS Health bonus, commission, or short-term incentive program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level