Analyst, Case Management- Field- Mountain Health Promise

CVS Health • Buckhannon, WV

13d • $21 - $37 • Hybrid

About The Position

CVS Health’s Aetna Better Health of West Virginia plan provides health care coordination and services to West Virginia’s Medicaid population and care coordination for children in complex foster care. The Analyst, Case Management uses critical thinking and judgment to collaborate on the case management process and help members achieve appropriate health care outcomes through care coordination, support, and education, using care management tools and resources.

This is a full-time field teleworker position requiring West Virginia residency in one of the specified Northern region counties. Travel in the assigned region is required at least 50% of the time and may involve 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 expense reimbursement policy.

The role evaluates members’ needs and eligibility, identifies risk factors and service needs, coordinates care plan activities, and monitors progress. It also works with case managers, supervisors, Medical Directors, and other programs to address barriers, raises quality-of-care concerns through established channels, and uses negotiation, motivational interviewing, coaching, and education to support member engagement and informed health decisions. Case management and quality management processes must be followed in compliance with regulatory and accreditation guidelines and company policies.

The position requires a qualifying bachelor’s degree or non-licensed master’s degree, relevant experience, reliable transportation, and the ability to meet the stated work-from-home and technical requirements. The company provides work equipment; the colleague supplies workspace furniture and must maintain a private, secure home workspace and a qualifying wired internet connection.

Requirements

• At least 2 years of experience in behavioral health, social services, or an appropriate related field equivalent to the program focus.
• West Virginia residency in one of the following counties: Barbour, Brooke, Doddridge, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Ritchie, Taylor, Tyler, Upshur, or Wetzel.
• Reliable transportation and willingness and ability 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 MS Office Suite applications including Outlook, Word, Excel, SharePoint, and Teams.
• A bachelor’s degree or non-licensed master’s degree is required.
• Ability to meet work-from-home requirements, including a direct wired internet connection with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
• Ability to maintain a quiet, secure, private, organized home work location that complies with CVS Health and HIPAA guidelines and permits uninterrupted work.
• Ability to work within the state and city where the employee has confirmed they currently live.
• Ability to supply workspace furniture, such as a desk or standing desk, and comply with the company’s work-from-home requirements.
• Comfort setting up and using multiple monitors and navigating multiple applications simultaneously.
• Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings.
• Experience using Microsoft Office 365 applications or similar tools such as Google Workspace.
• Ability to access secure systems such as VPNs and EHR portals, secure a computer when unattended, manage strong passwords, and recognize suspicious emails or links.
• Ability to troubleshoot common technical issues and contact IT for issues that cannot be resolved independently.
• 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.
• 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 care management tools and information or data review.
• Recommend approaches to case resolution and meeting member needs by reviewing 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 refer 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 overcome barriers to care goals and objectives.
• Present cases at case conferences for multidisciplinary review and to support optimal outcomes.
• Identify and escalate quality-of-care issues through established channels.
• Use negotiation skills to secure appropriate options and services that meet members’ benefit and health care needs.
• Use influencing and motivational interviewing skills to promote member engagement and healthy behavior changes.
• Provide coaching, information, and support that empower members to make ongoing independent medical and healthy lifestyle choices.
• Help members participate actively and knowledgeably in health care 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 to support colleagues and their families, based on eligibility.
• Eligibility for a CVS Health bonus, commission, or short-term incentive program.

What This Job Offers

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