Analyst, Case Management – Field in Tidewater Virginia Area

CVS Health•Hampton, VA

About The Position

This position supports members in the Tidewater Virginia area through care coordination, support, and education. The Analyst uses critical thinking and care management tools to evaluate members’ needs and eligibility, identify risk factors and service needs, and recommend approaches to resolve cases or meet member needs. The role coordinates assigned care plan activities, monitors progress, and refers members to clinical case management or crisis intervention when appropriate. The Analyst collaborates with case managers, supervisors, Medical Directors, and other health programs to address barriers and achieve optimal outcomes, including presenting cases for multidisciplinary review. The role identifies and escalates quality-of-care concerns, negotiates appropriate services, and uses motivational interviewing, coaching, and education to support member engagement, healthy lifestyle changes, and informed healthcare decision-making. The position applies case management and quality management processes in accordance with regulatory and accreditation guidelines and company policies and procedures. Candidates must reside in the Tidewater Virginia area. Up to 70% travel is required in the Central region.

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.
Up to 70% travel is required in the Central region.
Bachelor’s degree or non-licensed master-level clinician required.

Nice To Haves

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

Responsibilities

Evaluate members’ needs and eligibility using care management tools and information, and recommend approaches to case resolution or meeting member needs.
Identify risk factors and service needs that may affect member outcomes and care planning; refer members to clinical case management or crisis intervention as appropriate.
Coordinate assigned care plan activities and monitor care plan progress.
Collaborate with case managers, supervisors, Medical Directors, and other health programs to address barriers to goals and objectives.
Present cases at conferences to obtain multidisciplinary review and support optimal outcomes.
Identify and escalate quality-of-care issues through established channels.
Negotiate appropriate options and services to meet members’ benefits and healthcare needs.
Use motivational interviewing to engage members and promote lifestyle or behavior changes.
Provide coaching, information, and support to empower members to make independent medical and healthy-lifestyle choices.
Help members participate knowledgeably with providers in healthcare decision-making.
Apply case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.