Analyst, Case Management, Field

Summary

CVS Health is a healthcare company focused on creating a more connected, convenient, and compassionate health experience. The Analyst, Case Management, Field supports care management and care coordination activities by assessing member needs, developing and monitoring care plans, coordinating services, educating members, and collaborating with interdisciplinary healthcare teams.

Responsibilities

• Uses care management tools and information to complete a comprehensive evaluation of members and recommends an approach to case resolution by determining member needs in alignment with their benefit plan and available internal and external programs and services
• Identifies high risk factors and service needs that may impact member outcomes and care planning with appropriate referral to clinical case management or crisis intervention as appropriate
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve an 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
• Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access
• Coordinates and implements assigned care plan activities and monitors care plan progress
• Using a holistic approach consults with clinical care managers, leadership, medical directors and other physical/behavioral health support staff and providers to overcome barriers to meeting member goals and objectives
• Presents cases at case conferences/rounds to obtain multidisciplinary review in order to achieve optimal outcomes
• Works collaboratively with the members’ interdisciplinary care team
• In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals
• Identifies and escalates quality of care issues through established channels
• Monitors, evaluates and documents care utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
• Identifies, refers, and links members to providers and social supports as needed (e.g., scheduling appointments, arranging transportation)
• Educates members about available resources and services such as Texas value-added benefits and assisting the member in accessing those resources and services
• Facilitates clinical hand-offs during transitions of care
• Willing and able to travel 10-20% of their time to meet members face to face in member service areas
• Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policy
• Consistently meets defined performance and productivity standards
• Ability to work two (2) evenings a week to 9pm
• Other duties as assigned
• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3mbs upload. WiFi and satellite internet are not permitted
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time)
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements
• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace)
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Skills

• Minimum of 2 years of experience in care management, rehabilitation services, health services, social services coordination, or behavioral health
• Strong assessment, care coordination, and care planning skills
• Ability to engage members using motivational interviewing and person-centered care approaches
• Effective communication and collaboration skills with members, providers, and interdisciplinary teams
• Willingness and ability to travel 10-20% locally for member visits; reliable transportation required
• Ability to work remotely and meet work-from-home and technology requirements
• Ability to work two evenings per week until 9:00 PM
• Bachelor's degree in Social Work, Psychology, Human Services, Counseling, Sociology, or a related social services field
• Licensed Behavioral Health Professional in the State of Texas, as applicable to role requirements
• Case management and discharge planning experience
• Managed care experience
• Experience supporting maternity populations
• Knowledge of community resources and social service programs
• Experience working within interdisciplinary healthcare teams

Qualifications

Must Haves

• Minimum of 2 years of experience in care management, rehabilitation services, health services, social services coordination, or behavioral health
• Strong assessment, care coordination, and care planning skills
• Ability to engage members using motivational interviewing and person-centered care approaches
• Effective communication and collaboration skills with members, providers, and interdisciplinary teams
• Willingness and ability to travel 10-20% locally for member visits; reliable transportation required
• Ability to work remotely and meet work-from-home and technology requirements
• Ability to work two evenings per week until 9:00 PM
• Bachelor's degree in Social Work, Psychology, Human Services, Counseling, Sociology, or a related social services field
• Licensed Behavioral Health Professional in the State of Texas, as applicable to role requirements

Nice to Haves

• Case management and discharge planning experience
• Managed care experience
• Experience supporting maternity populations
• Knowledge of community resources and social service programs
• Experience working within interdisciplinary healthcare teams

Benefits

• CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
• Medical, dental, and vision coverage, based on eligibility.
• Paid time off, based on eligibility.
• Retirement savings options, based on eligibility.
• Wellness programs, based on eligibility.
• Other resources supporting the physical, emotional, and financial well-being of colleagues and their families, based on eligibility.
• Mileage is reimbursed per our company expense reimbursement policy.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.).
• Remote work arrangement within the state and city where the colleague currently lives.