Analyst, Case Management Specialist

at  CVS Health

Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members. Helps implement projects, programs, and processes for Case Management. Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area. Consults with Nurse Case Managers, Supervisors, Medical Directors and/or other members of the Care team using a holistic approach. Presents cases at case conferences to obtain a multidisciplinary review in order to achieve optimal outcomes. Identifies and escalates quality of care issues through established channels. Demonstrates negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs. Delivers 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. Assists in encouraging members to actively participate with their provider in healthcare decision-making. Conducts comprehensive evaluations of referred members’ needs/eligibility using care management tools and recommends an approach to case resolution.

REQUISITION JOB DESCRIPTION

This is a full-time telework position with less than 10% travel required.
Hours for this position are Monday-Friday 8:00am - 5:00pm in time zone of residence.

REQUIRED QUALIFICATIONS

• 3+ years experience in health-related field

PREFERRED QUALIFICATIONS

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

EDUCATION

• Bachelor’s Degree or equivalent experience

Please refer the Job description for details