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

CVS Health • Oak Park, IL

23h • $21 - $45 • Onsite

About The Position

The Analyst Case Manager assesses, plans, implements, and coordinates case management activities by phone and/or face to face. The role evaluates members’ medical needs and supports their overall wellness. It is field-based, with 50–75% travel to meet members in Chicago and surrounding areas; candidates must live in DuPage County, Western Cook County, or surrounding areas in Illinois. The schedule is Monday through Friday during standard business hours, 8:00 a.m.–4:30 p.m. CST.

The position develops proactive courses of action to address member concerns and improve short- and long-term outcomes. It uses clinical tools, information and data review, and clinical judgment to assess needs, benefit eligibility, risk factors, barriers, and health and social indicators that affect care planning. Assessments consider multiple and comorbid conditions, work capacity, and relevant restrictions or limitations. The Analyst Case Manager may refer members to clinical resources, coordinate transitions to Aetna programs and plans, review prior claims, consult with supervisors and colleagues, and present cases at multidisciplinary conferences. The role uses interviewing skills to engage members and understand their health status and needs, and follows regulatory and company policies and procedures.

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 MS Office suite applications.
• Must be willing and able to travel 50–75% of the time using a personal vehicle to meet members face to face in Chicago and surrounding areas.
• Reliable transportation is required.
• Bachelor’s degree required, 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.
• A non-licensed master’s degree.

Responsibilities

• Assess, plan, implement, and coordinate case management activities with members by phone and/or face to face.
• Develop proactive courses of action to address issues and improve members’ short- and long-term outcomes and overall wellness.
• Use clinical tools and information and data review to evaluate member needs and benefit plan eligibility, facilitate integrative 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.
• Assess conditions, including comorbidities and multiple diagnoses that affect functionality, as well as members’ work capacity and related restrictions or limitations.
• Use a holistic approach to assess whether referral to clinical resources is needed to determine functionality.
• Review prior claims for potential impact on current case management and eligibility.
• Consult with supervisors and others to overcome barriers to goals and objectives, and present cases at conferences for multidisciplinary case management.
• Use case management processes in compliance with regulatory and company policies and procedures.
• Use interviewing skills to engage members and determine their health status and needs.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility
• May be eligible for a CVS Health bonus, commission, or short-term incentive program

What This Job Offers

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