Case Management Analyst - Field in St. Clair County IL or surrounding area
About The Position
The Case Management Analyst facilitates appropriate healthcare outcomes for members by providing care coordination, support, and education through care management tools and resources. The role evaluates referred members’ needs and eligibility, recommends case-resolution approaches using benefit-plan information and available programs, identifies high-risk factors and service needs, and coordinates and monitors assigned care-plan activities. It uses a holistic approach and works with case managers, supervisors, Medical Directors, and other health programs to address barriers, improve quality of care, and support optimal outcomes. The analyst also helps members engage in healthcare decision-making and make informed, independent medical and healthy-lifestyle choices. The position is based in St. Clair County or the surrounding area in Illinois and requires up to 75% travel in St. Clair County and surrounding counties. Mileage is reimbursed under the company expense reimbursement policy.
Requirements
- Must reside in Illinois in St. Clair County or the surrounding area.
- Valid Illinois driver’s license.
- Reliable transportation and willingness and ability to travel up to 75% of the time.
- At least two years of case-management experience.
- Microsoft Office and electronic health record experience.
- Bachelor’s degree in a human-services field, or a master’s degree in a human-services field for a non-licensed individual; examples include sociology, special education, and rehabilitation counseling.
Nice To Haves
- Case-management and discharge-planning experience.
- Managed-care experience.
- Microsoft Office experience.
Responsibilities
- Evaluate referred members’ needs and eligibility using care-management tools and information or data review.
- Recommend approaches to case resolution and meeting members’ needs by evaluating benefit plans and available internal and external programs or services.
- Identify high-risk factors and service needs that may affect member outcomes and care planning; 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 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 that meet members’ benefit or healthcare needs.
- Use influencing and motivational-interviewing skills to encourage member engagement and lifestyle or behavior changes.
- Provide coaching, information, and support so members can make ongoing independent medical and healthy-lifestyle choices.
- Help members participate actively and knowledgeably in healthcare decision-making with their providers.
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
