Analyst, Case Management- Field- Mountain Health Promise

CVS Health • Fairmont, WV

11d • Hybrid

About The Position

The Analyst, Case Management supports the Aetna Better Health of West Virginia plan and its care coordination work with the state’s Medicaid population, including complex foster care children. This full-time field teleworker position requires West Virginia residency in one of the listed Northern region counties and travel in the assigned region 50% or more of the time. Field travel 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 role uses critical thinking and judgment to collaborate in the case management process and help members achieve appropriate healthcare outcomes through care coordination, support, and education. The Analyst evaluates referred members’ needs and eligibility, identifies risks and service needs, recommends approaches to resolving cases, coordinates care plan activities, and monitors progress. The position works with case managers, supervisors, Medical Directors, and other health programs to address barriers, participates in case conferences, escalates quality-of-care concerns, and helps members access appropriate benefits and services. It also supports member engagement and informed healthcare decision-making through coaching, motivational interviewing, and education.

The position follows case management and quality management processes in accordance with regulatory and accreditation guidelines and company policies. Work-from-home requirements include a quiet, secure, private workspace that complies with CVS Health and HIPAA guidelines, a direct wired internet connection meeting specified speed requirements, and the ability to work from the state and city where the colleague resides. CVS Health provides work equipment; colleagues provide their own workspace furniture. The role requires comfort using multiple monitors and applications, digital communication and collaboration tools, secure systems, and basic technical troubleshooting.

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 these counties: Barbour, Brooke, Doddridge, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Ritchie, Taylor, Tyler, Upshur, or Wetzel.
• Must have reliable transportation and be willing and able to travel in the assigned region 50% or more of the time.
• At least 2 years of experience using a personal computer, keyboard, mouse, and multiple systems, and with MS Office Suite applications including Outlook, Word, Excel, SharePoint, and Teams.
• Bachelor’s degree or non-licensed master-level clinician required.
• Must have or be able to obtain a direct, hardwired internet connection to a modem or router within 7 feet of the computer, with minimum speeds of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not permitted.
• Must maintain a quiet, secure, private, organized home work location compliant with CVS Health and HIPAA guidelines and free from distractions.
• Must work from within the state and city where currently residing.
• Must provide workspace furniture, such as a desk or standing desk, and commit to meeting work-from-home requirements.
• Must be comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Must be able to communicate through email, calendar invitations, Teams messaging, and virtual meetings.
• Must be able to use Microsoft Office 365 applications or similar tools such as Google Workspace.
• Must be able to access secure systems, lock an unattended computer, manage strong passwords, and recognize suspicious emails or links.
• Must be able to troubleshoot common technical issues independently and contact IT for unresolved issues.
• Must be open 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.
• A 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 case management tools and information or data review, and recommend approaches to resolve cases or meet needs based on 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 care plan progress.
• Consult with case managers, supervisors, Medical Directors, and other health programs to address barriers to goals and objectives.
• Present cases at case conferences to obtain multidisciplinary review and support optimal outcomes.
• Identify and escalate quality-of-care issues through established channels.
• Use negotiation skills to secure appropriate options and services to meet members’ benefit and healthcare needs.
• Use influencing and motivational interviewing skills to promote member engagement and lifestyle or behavior changes.
• Provide coaching, information, and support so members can make ongoing independent medical and healthy lifestyle choices.
• Help members participate actively and knowledgeably in healthcare decision-making with their providers.
• 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.
• Eligible for a CVS Health bonus, commission, or short-term incentive program.
• Mileage reimbursement under the company expense reimbursement policy.
• Company-provided equipment, including keyboard, monitor, computer, and headset.

What This Job Offers

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