Analyst, Case Management Field

Health Case Manager

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable 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

Utilizes critical thinking and judgment to collaborate and inform the case management process to facilitate appropriate healthcare outcomes 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 member's needs and 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 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 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 healthcare needs.

Utilizes 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 members to make ongoing independent medical and/or healthy lifestyle choices.

Helps members 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.

Required Qualifications

Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling), LMHP, RN/LPN, QMHP, LMSW, LBSW, MSW or BSW.

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

Up to 70% travel will be required in Central region.

Preferred Qualifications

Case management and discharge planning experience preferred.

Managed Care experience preferred.

Education

Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling), LMHP, RN/LPN, QMHP, LMSW, LBSW, MSW or BSW.

Job Families for Job Profiles

Clinical Support

Worker Sub-Type

Regular

Time Type

Full time

Remote Type

Work At Home-Virginia

Primary Location

VA - Work from home

Additional Locations

Additional Job Posting Locations

Scheduled Weekly Hours

40

Anticipated Weekly Hours

40

Pay Range

The typical pay range for this role is:

$21.10 - $40.90

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. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

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

We anticipate the application window for this opening will close on: 06/06/2026

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