Analyst, Case Management Specialist (Central Time Zone)

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.

ESSENTIAL QUALIFICATIONS AND FUNCTIONS:

• Regular and reliable attendance
• Familiar with community resources & services
• Strong organizational skills
• Works independently.
• Maintains professional relationships with the members we serve as well as colleagues.
• Communicates effectively and professionally verbally and in writing.
• Proficient with computer systems
• Knowledgeable in Microsoft Office Software
• Excellent customer service skills
• Has a dedicated homework space

REQUIRED QUALIFICATIONS:

• 3+ years’ experience in health-related field
• 2+ years of customer service experience
• 2+ years of experience with claims

PREFERRED QUALIFICATIONS:

• Master’s degree preferred
• CRC, CDMS, CRRN, COHN, or CCM certification
• Medicare and Medicaid experience
• Managed care experience
• Experience working with geriatric special needs, behavioral health and disable population.
• Knowledge of assessment, screenings, and care planning
• Bilingual (English/Spanish; English/Creole)

EDUCATION:

• Bachelor’s degree or equivalent experience required.

JOB PURPOSE AND SUMMARY:

The Care Manager is a member of the Care Team. The Care Manager is responsible for the care management of members that are enrolled in the Dual Special Needs Plan and have limited health conditions. These members are usually stratified as low risk. The Care Manager will work in conjunction with the Nurse Care Manager, Care Coordinator, Transition of Care (TOC) Coach, and other members of the Care Team to improve the member’s health outcomes, address social determinants of health and connect members with community-based organizations. The Care Manager will assess member’s needs as well as gaps in care, communicate with the member’s Primary Care Provider (PCP), maintain updated individualized care plans and participate in Interdisciplinary team meetings. Care Managers will be able to identify members whose needs require clinician involvement and transition members appropriately.

RESPONSIBILITIES:

• Responsible for interacting with low stratification members via phone calls, coordinating care, completing, reviewing, and updating assessments and care plans that address problems, goals and interventions.
• Based on assessments and claims data creates a care plan for members to follow
• Participate as a member of the Care Team during Interdisciplinary Team meetings to discuss the member’s health care needs, barriers to care and explore better outcomes for the member.
• Identify and link members with health plan benefits and community resources Perform administrative work to maintain skills needed for job duties