Analyst, Case Management- Field- Mountain Health Promise

CVS Health • Buckhannon, WV

2d • $21 - $37 • Hybrid

About The Position

The Analyst, Case Management supports Aetna Better Health of West Virginia’s Mountain Health Promise program by coordinating care for members and helping facilitate appropriate healthcare outcomes. The role uses critical thinking and judgment, case management tools, and available data to assess referred members’ needs and eligibility, identify risks and service needs, and recommend approaches to resolving cases. It coordinates and monitors assigned care plan activities and connects members with appropriate internal and external programs and services.

The analyst works with case managers, supervisors, Medical Directors, and other health programs to address barriers, participates in case conferences, escalates quality-of-care concerns, and uses negotiation and motivational interviewing to promote member engagement and informed healthcare and lifestyle choices. The position follows regulatory, accreditation, and company policies and procedures.

This is a full-time field teleworker position requiring residence in West Virginia, specifically in one of the listed Northern-region counties. Travel in the assigned region is required at least 50% of the time and may include visits to 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 also requires a secure, private home workspace and a direct wired internet connection meeting the stated speed requirements.

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 at least 50% of the time.
• At least 2 years of experience using a personal computer, keyboard, mouse, and multiple systems, as well as Microsoft Office Suite applications including Outlook, Word, Excel, SharePoint, and Teams.
• Bachelor’s degree or non-licensed master-level clinician required.
• Must meet work-from-home requirements, including a direct wired internet connection with at least 25 Mbps download and 3 Mbps upload, and a quiet, secure, private designated workspace compliant with company and HIPAA guidelines.
• Must be able to set up and use multiple monitors and navigate multiple applications simultaneously.
• Must be able to use digital communication tools, secure systems such as VPN and EHR portals, and appropriate computer security practices.
• Must be able to troubleshoot common technical issues and contact IT for issues that cannot be resolved independently.
• Must provide workspace furniture, such as a desk or standing desk, and commit to meeting the work-from-home requirements.

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.
• Experience with Microsoft Office 365 applications, including Teams, Outlook, Word, Excel, and PowerPoint, or similar Google Workspace applications.

Responsibilities

• Evaluate referred members’ needs and eligibility using case management tools and information or data review.
• Recommend approaches to case resolution and meeting member needs by assessing 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 progress.
• Consult with case managers, supervisors, Medical Directors, and other health programs to address barriers to care 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’ benefits and healthcare needs.
• Use influencing and motivational interviewing skills to encourage member engagement and lifestyle or 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 with their providers in healthcare decision-making.
• 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, based on eligibility.
• Eligible for a CVS Health bonus, commission, or short-term incentive program in addition to base pay.

What This Job Offers

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