Analyst, Case Management - Field - Must live in Louisiana Region 7

CVS Health•Monroe, LA

2d•Hybrid

About The Position

Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members. Helps implement projects, programs, and processes for Case Management. Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area. Consults with case managers, supervisors, medical directors and/or other health programs using a holistic approach, to overcome barriers to meeting goals and objectives. Presents cases at case conferences to obtain a multidisciplinary review in order to achieve optimal outcomes. Identifies and escalates quality of care issues through established channels. Demonstrates negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs. Delivers 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. Assists in encouraging members to actively participate with their provider in healthcare decision-making. Conducts comprehensive evaluations of referred members’ needs/eligibility using care management tools and recommends an approach to case resolution.

Requirements

Must live in Louisiana Region 7 (Alexandria/Shreveport): Northwest parishes (Caddo, Bossier, Webster, Claiborne, Bienville, Red River, Desoto, Sabine, Natchitoches)
Degree in Health Care/Human Services related field
Case Management Experience
Strong customer service orientation and problem solving skills
Excellent communication/telephonic skills
Excellent motivational interviewing skills/ability to build rapport and trust telephonically
Excellence in documentation and respecting compliance/regulatory standards
Highly organized, remain self-driven without direct supervision
Manage time effectively
Achieve performance metrics
Technology proficiency
Highly organized, remain self-drive without direct supervision
Ability to travel within 125 miles round trip for 1 day in the field
Variable work scheduled with ability to work 2 days weekly until 9pm local time

Nice To Haves

Bachelors and/or Master's Degree
CCM certification
Previous experience in managed care organization

Responsibilities

Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members.
Helps implement projects, programs, and processes for Case Management.
Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area.
Consults with case managers, supervisors, medical directors and/or other health programs using a holistic approach, to overcome barriers to meeting goals and objectives.
Presents cases at case conferences to obtain a multidisciplinary review in order to achieve optimal outcomes.
Identifies and escalates quality of care issues through established channels.
Demonstrates negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
Delivers 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.
Assists in encouraging members to actively participate with their provider in healthcare decision-making.
Conducts comprehensive evaluations of referred members’ needs/eligibility using care management tools and recommends an approach to case resolution.