Analyst Case Management, Field - Must live in Louisiana

Case Management Coordinator

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 The Case Management Coordinator (CMC) 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 through the use of care management tools and resources. This position is in the ABH- Louisiana Care Management Program. Schedule is Monday-Friday standard business hours 8 AM- 5 PM. No nights, no weekends, and no holidays. Must live in Region 1 - Orleans, Jefferson, St. Bernard, Plaquemines or Region 4 Evangeline, St. Landry, Acadia, Lafayette, St. Martin, Iberia, Vermillion

Evaluation of Members:

• Using 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 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 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.

Required Qualifications

• 2+ years' experience in behavioral health, social services or appropriate related field equivalent to program focus.
• 2+ years' experience with adult and/or adolescent populations.
• Must reside in Louisiana
• Must have reliable transportation and be willing and able to travel 50% of the time or more. Mileage is reimbursed per company expense reimbursement policy

Preferred Qualifications

• Medicaid experience.
• Waiver experience
• Crisis intervention skills
• Managed care/utilization review experience
• Familiarity with QuickBase
• Case management and discharge planning experience
• Demonstrated proficiency with personal computer, keyboard navigation, and mouse
• Familiarity and proficiency with MS Office Suite applications including MS Teams, Outlook, Word, Excel, and SharePoint.

Education Minimum of a Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (i.e., psychology, social work, marriage and family therapy)

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$21.10 - $36.78

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.

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.