Analyst, Case Management
About The Position
The Analyst, Case Management Field conducts routine care coordination, support, and education for members using care management resources to facilitate appropriate healthcare outcomes. The role applies case management principles to assess member needs, address barriers to care, connect members with appropriate resources, and empower them to make informed healthcare decisions. It requires strong communication, motivational interviewing, documentation, and organizational skills, while maintaining compliance with regulatory and organizational standards. The Analyst coordinates care and supports members through assessment, education, advocacy, and resource navigation. Working collaboratively with healthcare providers, care teams, and community partners, the Analyst helps members achieve optimal health outcomes by addressing healthcare needs, promoting self-management, and facilitating access to appropriate services and benefits. Success requires excellent customer service, problem-solving abilities, and the ability to build rapport and trust telephonically.
Requirements
- At least two years of experience in case management, behavioral health, social services, healthcare, or a related field.
- Experience working with adult and/or adolescent populations.
- Strong customer service orientation and problem-solving skills.
- Excellent verbal, written, and telephonic communication skills.
- Demonstrated motivational interviewing skills and ability to establish rapport and trust telephonically.
- Strong attention to detail and exceptional documentation skills.
- Commitment to compliance, regulatory requirements, and quality standards.
- Highly organized and self-motivated, with the ability to work independently with minimal supervision.
- Strong time management and multitasking abilities.
- Proficiency with computers and technology platforms used for case management and documentation.
- Ability to interface effectively with members, providers, and internal stakeholders.
- Ability to work a variable schedule, including two evenings per week until 9:00 PM local time.
- Ability to meet established performance and productivity metrics.
- Bachelor's degree in Healthcare, Human Services, Social Work, Psychology, Sociology, Public Health, or a related field.
Nice To Haves
- Medicaid experience.
- Waiver program experience.
- Managed Care Organization (MCO) experience.
- Certified Case Manager (CCM) certification.
- Master's degree in a healthcare, social services, or related field.
- Crisis intervention experience and skills.
- Utilization review experience.
- Case management and discharge planning experience.
- Experience with QuickBase or similar case management platforms.
- Proficiency with Microsoft Teams, Outlook, Word, Excel, and SharePoint.
- Previous experience coordinating care for complex populations.
Responsibilities
- Conduct comprehensive assessments to evaluate member needs, eligibility, barriers to care, and opportunities for intervention.
- Provide routine care coordination, support, and education to members to improve health outcomes.
- Use motivational interviewing techniques to increase member engagement and promote healthy lifestyle changes.
- Empower members to make informed healthcare decisions and actively participate in their care plans.
- Collaborate with case managers, supervisors, medical directors, providers, and other healthcare professionals to address member needs.
- Present cases at interdisciplinary case conferences to support optimal member outcomes.
- Identify and escalate quality-of-care concerns through established channels.
- Assist members in accessing appropriate services, benefits, and community resources.
- Use negotiation skills to secure services and support necessary to meet member needs.
- Maintain accurate, timely, and compliant documentation of case management activities.
- Meet productivity, quality, and performance metrics while managing a diverse caseload.
- Support implementation of case management programs, projects, policies, and processes.
- Use technology and multiple systems to support member care and documentation requirements.
- Manage workload independently while maintaining organizational priorities and deadlines.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- CVS Health bonus, commission, or short-term incentive program eligibility
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
