Case Management Analyst- Field

CVS Health

1d•Hybrid

About The Position

This is a full-time field teleworker position that requires West Virginia residency and significant travel (50% or more) within the East region of WV, including member homes, residential treatment facilities, group homes, shelters, and detention facilities. Qualified candidates must reside in specific WV counties (Morgan, Jefferson, Berkeley, Hampshire, Mineral, Grant, Hardy, Pendleton, Randolph, Tucker, and Preston). The role involves utilizing critical thinking and judgment to collaborate and inform the case management process, facilitating appropriate healthcare outcomes for members by providing care coordination, support, and education through care management tools and resources. The schedule is Monday-Friday standard business hours, with no nights, weekends, or holidays.

Requirements

2 years’ experience in behavioral health, social services, or appropriate related field equivalent to program focus
West Virginia resident residing in one of the following counties: Morgan, Jefferson, Berkeley, Hampshire, Mineral, Grant, Hardy, Pendleton, Randolph, Tucker, and Preston.
Must possess reliable transportation and be willing and able to travel in the assigned region 50% or more of the time.
2+ years of experience with personal computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams)
Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling).

Nice To Haves

Medicaid experience.
Waiver experience
Foster care experience
Crisis intervention skills
Managed care/utilization review experience
Case management and discharge planning experience
Familiarity with QuickBase

Responsibilities

Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred 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 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.
Helps member actively and knowledgeably 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.