Analyst Case Management - Field in DuPage County or Western Cook County Illinois

CVS Health•Naperville, IL

2d•Onsite

About The Position

This is a field-based case management position serving members in Chicago, Illinois, and surrounding areas. The role requires 50–75% travel for face-to-face member visits, and the candidate must live in DuPage County, Western Cook County, or the surrounding areas. The schedule is Monday through Friday during standard business hours, 8:00 a.m. to 4:30 p.m. CST. The Analyst Case Manager assesses, plans, implements, and coordinates case management activities by phone and in person to evaluate members’ medical needs and support their overall wellness. The position uses clinical tools, information and data review, and member interviews to identify needs, evaluate benefit-plan eligibility, coordinate services, address risk factors and barriers, and support transitions to Aetna programs and plans. Assessments consider co-morbidities, multiple diagnoses, prior claims, work capacity, restrictions, and limitations. The role also works with supervisors and multidisciplinary colleagues to address barriers and support effective claim management, while following regulatory and company policies and procedures. The role requires a bachelor’s degree and at least two years of case management practice experience, along with at least one year of experience using Microsoft Office applications. The employee must be willing and able to use their own vehicle for required travel; mileage is reimbursed under the company expense reimbursement policy. The position is full-time, 40 hours per week, with a stated pay range of $21.10–$44.99. It is eligible for a CVS Health bonus, commission, or short-term incentive program, as well as a benefits package that includes medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, subject to eligibility.

Requirements

Must reside in DuPage County, Western Cook County, or surrounding areas in Illinois.
At least 2 years of case management practice experience.
At least 1 year of experience with Microsoft Office suite applications.
Willing and able to travel 50–75% of the time using a personal vehicle for face-to-face member visits.
Reliable transportation.
Bachelor’s degree, preferably in social work, psychology, nursing, human services, or a related field.

Nice To Haves

Case management experience in an integrated model.
Experience working with adults with behavioral health needs.
Long-term care experience in a nursing home setting.
Non-licensed master’s degree.

Responsibilities

Assess, plan, implement, and coordinate case management activities by telephone and/or face to face to evaluate members’ medical needs and support overall wellness.
Develop proactive courses of action to address issues and improve short- and long-term outcomes and member wellness through service integration.
Use clinical tools and information and data review to evaluate member needs and benefit-plan eligibility, facilitate integrated functions, and support transitions to Aetna programs and plans.
Apply clinical judgment to reduce risk factors and barriers and address complex health and social indicators affecting care planning and resolution of member issues.
Conduct assessments that consider all conditions, including co-morbidities and multiple diagnoses affecting functionality.
Review prior claims for potential effects on current case management and eligibility.
Assess members’ work capacity and related restrictions or limitations.
Use a holistic approach to assess the need for referrals to clinical resources to help determine functionality.
Consult with supervisors and others to overcome barriers to goals and objectives, and present cases at case conferences for multidisciplinary focus on claim management.
Follow case management processes in compliance with regulatory requirements and company policies and procedures.
Use interviewing skills to engage members and determine their health status and needs through key questions and conversation.
Travel to meet members face to face in Chicago and surrounding areas using a personal vehicle.