Analyst, Case Management – Field in Tidewater Virginia Area

CVS Health•Hampton, VA

1d•$21 - $41

About The Position

This position serves candidates residing in the Tidewater Virginia area and requires up to 70% travel. The Analyst, Case Management uses critical thinking and judgment to collaborate on the case management process and support appropriate healthcare outcomes for members through care coordination, support, and education. The role evaluates members’ needs and eligibility, considers benefit plans and available programs and services, identifies risks and service needs, and recommends approaches to resolve cases or meet member needs. It coordinates and monitors care plan activities, collaborates with case managers, supervisors, Medical Directors, and other health programs, and escalates quality-of-care issues. The position also uses negotiation and motivational interviewing to help members access appropriate services, engage in care, make informed healthcare decisions, and pursue healthy lifestyle changes. Case management and quality management processes must be followed in accordance with applicable regulatory and accreditation guidelines and company policies.

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 Tidewater Virginia area.
Bachelor’s degree or non-licensed master-level clinician; either degree in behavioral health or human services is preferred.

Nice To Haves

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

Responsibilities

Use critical thinking and judgment to collaborate on case management and facilitate appropriate healthcare outcomes through care coordination, support, and education.
Evaluate members’ needs and eligibility using care management tools and information, and recommend approaches to case resolution or meeting member needs.
Evaluate members’ benefit plans and available internal and external programs and services.
Identify risk factors and service needs that may affect member outcomes and care planning, referring 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 goals and objectives.
Present cases at case conferences for multidisciplinary review and optimal outcomes.
Identify and escalate quality-of-care issues through established channels.
Negotiate to secure appropriate options and services that meet members’ benefit and healthcare needs.
Use motivational interviewing to support member engagement and lifestyle or behavior changes.
Coach, inform, and support members in making independent medical and healthy lifestyle choices.
Help members participate actively and knowledgeably in healthcare decisions with their providers.
Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.