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CVS Health · 14 hours ago

Analyst, Case Management

United States

Full-time

Remote

Entry, Mid Level

$21.10/hr - $49.08/hr

2+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care for millions of Americans. The Case Management Coordinator will utilize critical thinking and judgment to facilitate appropriate healthcare outcomes for members by providing assistance with appointment scheduling and access to benefits and education through care management tools.

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Responsibilities

Evaluation of Members: 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

Enhancement of Medical Appropriateness and Quality of Care: 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

Helps member actively and knowledgeably participate with their provider in healthcare decision-making

Monitoring, evaluation and documentation of care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Qualification

Behavioral health experienceCase management experienceMicrosoft OfficeDischarge planningManaged care experienceMotivational interviewingCoaching skillsCritical thinkingNegotiation skills

Required

2+ years experience in behavioral health or social services

Must have the ability to work 8:00a-5:00p in assigned market time zone. (EST/CST Primarily)

2+ years of experience with Microsoft Office Applications (Word, Excel, Outlook)

Preferred

Case Management and discharge planning experience

Managed Care experience

Benefits

Affordable medical plan options

401(k) plan (including matching company contributions)

Employee stock purchase plan

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

Paid time off

Flexible work schedules

Family leave

Dependent care resources

Colleague assistance programs

Tuition assistance

Retiree medical access