Analyst, Case Management Field

Were building a world of health around every individual shaping a more connected convenient and compassionate health experience. At CVS Health youll be surrounded by passionate colleagues who care deeply innovate with purpose hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger helping to simplify health care one person one family and one community at a time.

Position Summary

This position is for Virginia Only candidates with up to70% travel requiredin Central region Virginia

-Utilizes critical thinking and judgment to collaborate and inform the case management process tofacilitateappropriate healthcareoutcomes for members by providing care coordination support and education for members using care management tools and resources.

-Uses care management tools and information to evaluate members conducts comprehensive evaluation of members needs/eligibilityand recommends an approach to case resolution and/or meeting needs by evaluating members benefit plan and available internal and external programs/services.

Identifiesrisk factors and service needs that mayimpactmember outcomes and care planning components withappropriate referralto clinical case management or crisis intervention asappropriate.

-Coordinates and implements assigned care plan activities and monitors care plan progress.
-Enhancement of Medical Appropriateness and Quality of Care: - Usingholistic approachconsults with case managers supervisors MedicalDirectorsand/or other health programs to overcome barriers to meeting goals andobjectives presents cases at case conferences to obtain multidisciplinary review to achieveoptimaloutcomes.

-Identifiesand escalates quality of care issues through established channels.

-Utilizes negotiation skills to secureappropriate optionsand services necessary to meet the members benefits and healthcare needs.

-Utilizes motivational interviewing skills to ensuremaximummember engagement and promote lifestyle/behavior changes to achieveoptimumlevel of health.

-Provides coaching information and support to empower members to make ongoing independent medical and/or healthy lifestyle choices.

-Helpsmembersactively and knowledgablyparticipatewith 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.

Required Qualifications

-2 years experience in behavioral health socialservicesorappropriate relatedfield equivalent to program focus

-Must reside in Central Virginia Area

-Up to70% travel will berequiredin Central region

Preferred Qualifications

-Case management and discharge planning experience preferred

-Managed Care experience preferred

Education

-Bachelors degree or non-licensed master level clinicianrequired with either degree being in behavioral health or human services preferred (psychology social work marriage and family therapy counseling)

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience education geography and other relevant factors. This position is eligible for a CVS Health bonus commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers patients members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.