Analyst, Case Manager - Field Illinois (St Clair/Monroe/Madison/Bond Counties)

Field Analyst, 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.

Location: This is a full-time telework position requiring 50% travel in and around St Clair, Monroe, Madison, Bond and nearby counties in Illinois. Schedule: Standard business hours Monday-Friday 8:00am-5:00pm CST.

Position Summary

The Field Analyst, Case Manager utilizes critical thinking and judgment to collaborate and inform the case management process. The Analyst, Case Manager facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources.

Key Responsibilities

• Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of 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.
• Engages with colleagues in ongoing team meetings and offers peer mentoring/training.
• Helps member actively and knowledgably 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.

Remote Work Expectations

• Candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

Required Qualifications

• 2+ years experience in Behavioral Health, Social Services or appropriate related field equivalent to program focus.
• Must be willing and able to travel 50% of the time in and around St Clair, Monroe, Madison, Bond counties in Illinois.
• Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy.
• Must have 2+ years of experience of electronic documentation experience and Microsoft Office applications.

Preferred Qualifications

• Demonstrates confidence working remotely as an independent thinker, with the ability to effectively use virtual tools to collaborate and stay connected with team members.
• Case management and discharge planning experience.
• Managed Care experience.

Education

• Bachelor's degree or non-licensed master level clinician required with either degree being in Behavioral Health or Human Services (Psychology, Social Work, Marriage and Family therapy, Counseling)

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $21.10 - $44.99

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.