Analyst, Case Management- Field- Mountain Health Promise

CVS Health•Fairmont, WV

23h•Hybrid

About The Position

The Analyst, Case Management supports care coordination for members of Aetna Better Health of West Virginia, including complex foster-care children. The role uses critical thinking and judgment to facilitate appropriate healthcare outcomes by providing care coordination, support, and education through case-management tools and resources. This is a full-time field teleworker position requiring West Virginia residency and residence in one of the designated Northern-region counties: Barbour, Brooke, Doddridge, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Ritchie, Taylor, Tyler, Upshur, or Wetzel. Travel in the assigned region is required 50% or more of the time and 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. Mileage is reimbursed under the company expense reimbursement policy. The position evaluates members’ needs and eligibility, identifies risks and service needs, coordinates assigned care-plan activities, and monitors progress. It collaborates with case managers, supervisors, Medical Directors, and other programs to address barriers, participates in case conferences, escalates quality-of-care issues, and uses negotiation and motivational interviewing to support member engagement and informed healthcare decisions. It also applies case-management and quality-management processes in accordance with regulatory and accreditation guidelines and company policies. The role requires a designated quiet, secure, private, and organized home workspace compliant with CVS Health and HIPAA guidelines. A direct, hardwired internet connection to a modem/router within seven feet of the computer is required, with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted. The company provides work equipment such as a keyboard, monitor, computer, and headset. The colleague must provide workspace furniture and work within the state and city where they have confirmed they live. The position involves extended periods at a desk and requires comfort using multiple monitors, applications, secure systems, and digital communication and collaboration tools.

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 the following 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, as well as MS Office Suite applications including Outlook, Word, Excel, SharePoint, and Teams.
Bachelor’s degree or non-licensed master-level clinician qualification required; a degree in behavioral health or human services is preferred.
Must have or be able to obtain a direct, hardwired internet connection with at least 25 Mbps download and 3 Mbps upload; Wi-Fi 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 within the state and city where the colleague has confirmed they currently live.
Must provide workspace furniture, such as a desk or standing desk, and commit to meeting work-from-home requirements.
Ability to set up and use multiple monitors and navigate multiple applications simultaneously.
Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings.
Experience with Microsoft Office 365 applications or similar tools such as Google Workspace.
Ability to access secure systems such as VPNs and EHR portals, secure devices and passwords, and recognize suspicious emails or links.
Ability to troubleshoot common technical issues independently and contact IT for unresolved issues.
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.
Bachelor’s or master’s 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.
Recommend approaches to resolve cases or meet member needs by evaluating 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 address barriers to goals and objectives.
Present cases at case conferences for multidisciplinary review and optimal outcomes.
Identify and escalate quality-of-care issues through established channels.
Use negotiation skills to secure appropriate options and services for members’ benefit and healthcare needs.
Use influencing and motivational interviewing skills to encourage member engagement and lifestyle or behavior changes.
Provide coaching, information, and support to help members make independent medical and healthy-lifestyle choices.
Help members participate actively and knowledgeably with providers in healthcare decision-making.
Use case-management and quality-management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Travel throughout the assigned region to field-based locations, including member homes and residential or community facilities.

Benefits

Medical coverage.
Dental coverage.
Vision coverage.
Paid time off.
Retirement savings options.
Wellness programs.
Other resources supporting physical, emotional, and financial well-being, subject to eligibility.
Eligibility for a CVS Health bonus, commission, or short-term incentive program in addition to base pay.
Mileage reimbursement under the company expense reimbursement policy.
Company-provided work equipment, including keyboard, monitor, computer, and headset.