Analyst, Case Manager - Illinois (Hybrid-Remote)

CVS Health•Work At Home-Illinois, IL

1d•Hybrid

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This is a remote role with 10% travel required in the area you live in Illinois. Travel may include occasional in-person member visits, and/or community resource coordination as needed. Standard business hours Monday-Friday 8:00am-5:00pm CST. The Hybrid Analyst, Case Manager utilizes critical thinking and judgment to collaborate and inform the case management process. The Analyst, Case Manager facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources.

Requirements

2+ years experience in Behavioral Health, Social Services or appropriate related field equivalent to program focus.
Must be willing and able to travel 10% of the time in the area you live in Illinois.
Reliable transportation required.
Must have 2+ years of experience of electronic documentation experience and Microsoft Office applications.

Nice To Haves

Demonstrates confidence working remotely as an independent thinker, with the ability to effectively use virtual tools to collaborate and stay connected with team members.
Case management and discharge planning experience.
Managed Care experience.

Responsibilities

Through the use of care management tools and information/data review, conducts comprehensive evaluation of member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
Coordinates and implements assigned care plan activities and monitors care plan progress.
Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
Identifies and escalates quality of care issues through established channels.
Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
Engages with colleagues in ongoing team meetings and offers peer mentoring/training.
Helps member actively and knowledgably participate with their provider in healthcare decision-making.
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.