Analyst, Case Management - Field

CVS Health • Summersville, WV

2d • $21 - $37 • Hybrid

About The Position

This full-time field teleworker role requires the employee to reside in West Virginia in Braxton, Calhoun, Clay, Fayette, Gilmer, Kanawha, Nicholas, Roane, or Webster-Regional county. Travel is required at least 50% of the time in the central region of West Virginia; field locations may include member homes, residential treatment facilities, group homes, shelters, and detention facilities. The schedule is Monday through Friday during standard business hours, with no nights, weekends, or holidays.

The Analyst uses critical thinking and judgment to collaborate on the case management process and support appropriate healthcare outcomes. The role coordinates care and provides member support and education using care management tools and resources. It evaluates referred members’ needs and eligibility, identifies risks and service needs, recommends case-resolution approaches, coordinates care-plan activities, and monitors progress. The Analyst works with case managers, supervisors, Medical Directors, and other health programs; presents cases for multidisciplinary review; escalates quality-of-care concerns; and uses negotiation, influencing, and motivational interviewing skills to help members access services, engage in care, and make informed healthcare and lifestyle choices. Case management and quality management work must comply with regulatory and accreditation guidelines and company policies and procedures.

The position is field-based and also requires a designated, quiet, secure, private home workspace that complies with CVS Health and HIPAA guidelines. A wired internet connection to a modem or router within seven feet of the computer is required, with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted. The company provides work equipment such as a keyboard, monitor, computer, and headset. The employee provides workspace furniture and must work from the state and city where they have confirmed they live. The role involves using multiple monitors and applications, digital communication and collaboration tools, secure systems, and common technical troubleshooting procedures.

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 West Virginia in Braxton, Calhoun, Clay, Fayette, Gilmer, Kanawha, Nicholas, Roane, or Webster-Regional county.
• Must have reliable transportation and be willing and able to travel in the assigned region at least 50% of the time.
• At least 2 years of experience using a personal computer, keyboard, mouse, and multiple systems, and using Microsoft Office Suite applications including Outlook, Word, Excel, SharePoint, and Teams.
• Bachelor’s degree or non-licensed master-level clinician qualification required; a degree in behavioral health or human services is preferred, including psychology, social work, marriage and family therapy, or counseling.
• Must have or be able to obtain a direct, hardwired internet connection within seven feet of the computer with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
• Must maintain a quiet, secure, private, designated home workspace that complies with CVS Health and HIPAA guidelines and permits uninterrupted work.
• Must work within the state and city where currently residing.
• Must provide workspace furniture, such as a desk or standing desk, and adhere to work-from-home requirements.
• Ability to set up and use multiple monitors and navigate multiple applications simultaneously.
• Ability to communicate using email, calendar invites, Teams messaging, and virtual meetings.
• Ability to use Microsoft Office 365 applications or similar tools such as Google Workspace.
• Ability to access secure systems, follow basic computer security practices, and recognize suspicious emails or links.
• Ability to resolve common technical issues independently and contact IT for issues that cannot be resolved.

Nice To Haves

• Medicaid experience.
• Waiver experience.
• Foster care experience.
• Crisis intervention skills.
• Managed care or utilization review experience.
• Case management and discharge planning experience.
• Familiarity with QuickBase.
• Degree in behavioral health or human services, such as psychology, social work, marriage and family therapy, or counseling.

Responsibilities

• Evaluate referred members’ needs and eligibility using care management tools and information or data review.
• Recommend approaches to case resolution and meeting member needs by evaluating benefit plans and available internal and external programs and services.
• Identify high-risk factors and service needs that may affect member outcomes and care planning, and make appropriate referrals to clinical case management or crisis intervention.
• Coordinate and implement assigned care-plan activities and monitor progress.
• Consult with case managers, supervisors, Medical Directors, and other health programs to address barriers to care goals and objectives.
• Present cases at case conferences for multidisciplinary review and optimal outcomes.
• Identify and escalate quality-of-care issues through established channels.
• Use negotiation skills to secure appropriate options and services for members’ benefits and healthcare needs.
• Use influencing and motivational interviewing skills to encourage member engagement and lifestyle or behavior changes.
• Provide coaching, information, and support so members can make independent medical and healthy-lifestyle choices.
• Help members participate actively and knowledgeably with providers in healthcare decisions.
• Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Travel within the assigned West Virginia region at least 50% of the time.
• Use multiple monitors and applications, digital communication and collaboration tools, secure systems, and perform common technical troubleshooting.

Benefits

• Medical coverage.
• Dental coverage.
• Vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources supporting colleagues’ physical, emotional, and financial well-being, based on eligibility.
• Eligible for a CVS Health bonus, commission, or short-term incentive program.
• Mileage reimbursement under the company expense reimbursement policy.

What This Job Offers

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