Analyst, Case Management

at  CVS Health

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

POSITION SUMMARY

• Analyst, Case Management (ACM) drive and support care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating).
• The ACM utilizes critical thinking and judgment to collaborate and inform the care management/care coordination process in order to facilitate appropriate healthcare outcomes for assigned members.
• They provide care coordination, support and education for members through the use of care management tools and resources.

REQUIRED QUALIFICATIONS

• 3+ years of related professional experience includes acting as a care manager, rehabilitation specialist, health specialist, or social services coordinator.
• 3+ years of experience in the Healthcare field.
• 3+ years of experience working with Microsoft Office applications.

PREFERRED QUALIFICATIONS

• Case management and discharge planning experience preferred
• Managed Care experience preferred
• Licensed Social Worker

EDUCATION

• Bachelor’s degree or non-licensed master level clinician required, with either degree being in behavioral health or human services required (psychology, social work, marriage and family therapy, counseling).

• 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 Oklahoma value-added benefits and assisting the member in accessing those resources and services.
• Facilitates clinical hand offs during transitions of care.