Case Management Analyst – Field

Job not on LinkedIn

🔥 4 minutes ago

⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

💵 $21 - $36 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Business Analyst

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Conduct comprehensive evaluations of referred members’ needs and eligibility using care management tools and data review • Recommend case-resolution approaches by evaluating benefit plans and internal and external programs/services • Identify high-risk factors and service needs affecting 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 overcome barriers • Present cases at case conferences for multidisciplinary review • Identify and escalate quality-of-care issues through established channels • Negotiate appropriate options and services to meet members’ benefits and healthcare needs • Use influencing and motivational interviewing skills to promote member engagement and healthy behavior changes • Provide coaching, information, and support for independent medical and healthy lifestyle choices • Help members participate knowledgeably in healthcare decision-making with providers • Apply case management and quality management processes in compliance with regulatory, accreditation, and company requirements • Travel to member homes, residential treatment facilities, group homes, shelters, and detention facilities in central West Virginia

🎯 Requirements

• 2 years’ experience in behavioral health, social services, or an appropriate related field equivalent to the program focus • West Virginia residency, residing in Braxton, Calhoun, Clay, Fayette, Gilmer, Kanawha, Nicholas, Roane, or Webster-Regional county • Reliable transportation and willingness and ability to travel 50% or more in the assigned region • 2+ years of experience with personal computers, 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; degree in behavioral health or human services preferred • Medicaid experience preferred • Waiver experience preferred • Foster care experience preferred • Crisis intervention skills preferred • Managed care/utilization review experience preferred • Case management and discharge planning experience preferred • Familiarity with QuickBase preferred • Monday-Friday standard business hours; no nights, weekends, or holidays • Direct/hardwired internet connection within 7 feet of the modem/router, with minimum 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not permitted • Quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Must provide own workspace furniture • Ability to obtain required internet speeds and comply with Work From Home requirements • Comfort setting up and using multiple monitors and navigating multiple applications • Ability to use email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals, follow computer security practices, manage strong passwords, and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently • Openness to learning new skills

🏖️ Benefits

• Mileage is reimbursed per company expense reimbursement policy • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being