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CVS Health · 1 day ago

Analyst, Case Management- Field

Baton Rouge, LA

Full-time

Hybrid

Entry, Mid Level

$21.10/hr - $36.78/hr

2+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care. The Case Management Coordinator (CMC) will utilize critical thinking to facilitate appropriate healthcare outcomes for members through care coordination, support, and education, while collaborating with various stakeholders to ensure optimal care delivery.

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Responsibilities

Using 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 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

Qualification

Behavioral health experienceCrisis intervention skillsCase management experienceMedicaid experienceUtilization review experienceQuickBase familiarityMS Office Suite proficiencyMotivational interviewingNegotiation skills

Required

2+ years' experience in behavioral health, social services or appropriate related field equivalent to program focus

2+ years' experience with adult and/or adolescent populations

Must reside in Louisiana

Must have reliable transportation and be willing and able to travel 50% of the time or more. Mileage is reimbursed per company expense reimbursement policy

Minimum of a Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (i.e., psychology, social work, marriage and family therapy

Preferred

Medicaid experience

Waiver experience

Crisis intervention skills

Managed care/utilization review experience

Familiarity with QuickBase

Case management and discharge planning experience

Demonstrated proficiency with personal computer, keyboard navigation, and mouse

Familiarity and proficiency with MS Office Suite applications including MS Teams, Outlook, Word, Excel, and SharePoint

Benefits

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.