Analyst, Case Management - Field

CVS Health • Charleston, WV

1d • Remote

About The Position

This is a full-time field teleworker position requiring residency in West Virginia, specifically in one of the listed central-region counties: Braxton, Calhoun, Clay, Fayette, Gilmer, Kanawha, Nicholas, Roane, or Webster-Regional. Travel in the assigned region is required 50% or more of the time and 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. Mileage is reimbursed under the company’s expense reimbursement policy.

The Analyst uses critical thinking and judgment to collaborate in the case management process and facilitate appropriate healthcare outcomes. The role provides care coordination, support, and education to members using care management tools and resources. The Analyst evaluates member needs and eligibility, identifies risks and service needs, recommends case-resolution approaches, coordinates care-plan activities, and monitors progress. The role also works with case managers, supervisors, Medical Directors, and other health programs to address barriers, reviews cases in multidisciplinary conferences, escalates quality-of-care concerns, and helps members engage in healthcare decisions and healthy lifestyle changes.

The position is a work-from-home role with specific technical and workspace requirements. The colleague must have or obtain a direct, hardwired internet connection to a modem/router 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. A quiet, secure, private, organized workspace compliant with company and HIPAA guidelines is required. Colleagues must work within the state and city where they currently live. The company provides computer equipment, including a keyboard, monitor, computer, and headset; the colleague provides workspace furniture. The role involves extended periods at a desk and use of multiple monitors and applications, digital communication tools, secure systems, and basic troubleshooting. The position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to base pay. The listed typical pay range is $21.10–$36.78 per hour.

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 one of the following counties: Braxton, Calhoun, Clay, Fayette, Gilmer, Kanawha, Nicholas, Roane, or Webster-Regional.
• Reliable transportation and willingness and ability to travel in the assigned region 50% or more of the time.
• At least 2 years of experience using a personal computer, keyboard, mouse, multi-system navigation, and MS Office Suite applications, including Outlook, Word, Excel, SharePoint, and Teams.
• Bachelor’s degree or non-licensed master-level clinician credential required; either degree being in behavioral health or human services is preferred.
• Must have or be able to obtain a direct, hardwired internet connection within seven feet of the computer, with minimum download speed of 25 Mbps and upload speed of 3 Mbps; Wi-Fi and satellite internet are not permitted.
• Must maintain a quiet, secure, private, organized home workspace compliant with company and HIPAA guidelines and be able to work without interruption during work hours.
• Must work within the state and city where currently living.
• Must provide workspace furniture, such as a desk or standing desk, and be able to work at a desk for extended periods.
• Ability to set up and use multiple monitors and navigate multiple applications simultaneously.
• Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings.
• Experience with Microsoft Office 365 applications or similar tools such as Google Workspace.
• Ability to access secure systems such as VPNs and EHR portals, follow computer and password security practices, and recognize suspicious emails or links.
• Ability to independently resolve common technical issues and contact IT for unresolved issues.
• Openness to learning new skills as the workplace environment evolves.

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

• Conduct comprehensive evaluations of referred members’ needs and eligibility using care management tools and information/data review.
• Recommend approaches to case resolution and meeting member needs by evaluating benefit plans and available internal and external programs or services.
• Identify high-risk factors and service needs that may affect member outcomes and care planning; refer 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 overcome barriers to 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 behavior or lifestyle changes.
• Provide coaching, information, and support to help members make 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 supporting colleagues’ physical, emotional, and financial well-being, based on eligibility.
• CVS Health bonus, commission, or short-term incentive program eligibility.
• Mileage reimbursement under the company expense reimbursement policy.
• Company-provided computer equipment, including keyboard, monitor, computer, and headset.

What This Job Offers

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