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CVS Health

Runs pharmacies, health plans and clinics

Analyst – Case Management

Case Management & AdvocacyConfirmed live in the last 24 hours
Full-time

About the Job

Requirements

  • Two years of experience in behavioral health, social services, or an appropriate related field equivalent to the program focus.
  • Must reside in the Tidewater Virginia area.
  • Must be able to travel up to 70% in the Central region.
  • A bachelor's degree or a non-licensed master's-level clinician is required; either degree being in behavioral health or human services is preferred, including psychology, social work, marriage and family therapy, or counseling.

Responsibilities

  • Use critical thinking and judgment to collaborate in the case management process and facilitate appropriate healthcare outcomes by providing members with care coordination, support, and education using care management tools and resources.
  • Evaluate members' needs and eligibility using care management tools and information, and recommend approaches to case resolution or meeting needs by evaluating benefit plans and available internal and external programs and services.
  • Identify risk factors and service needs that may affect member outcomes and care-planning components, and make appropriate referrals to clinical case management or crisis intervention.
  • Coordinate and implement assigned care plan activities and monitor care plan progress.
  • Consult with case managers, supervisors, Medical Directors, and other health programs to overcome barriers to goals and objectives; present cases at case conferences for multidisciplinary review and optimal outcomes.
  • Identify and escalate quality-of-care issues through established channels.
  • Use negotiation skills to secure appropriate options and services needed to meet members' benefits and healthcare needs.
  • Use motivational interviewing to engage members and promote lifestyle or behavior changes that support optimal health.
  • Provide coaching, information, and support to empower members to make ongoing independent medical and healthy lifestyle choices.
  • Help members actively and knowledgeably participate in healthcare decision-making with their providers.
  • Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Desired Qualifications

  • Case management and discharge planning experience is preferred.
  • Managed care experience is preferred.

About the Company

CVS Health

Runs pharmacies, health plans and clinics

CVS Health runs pharmacies, health insurance plans and medical clinics for individuals, employers and government programs across the United States. Its businesses include CVS Pharmacy, the Aetna insurer and Caremark, which manages prescription coverage and negotiates drug prices for health plans. Patients fill prescriptions in stores or by mail and receive care through walk-in clinics, primary care centers and home visits. The company earns money from prescription sales, insurance premiums, plan administration fees and clinical services, combining coverage with places to obtain treatment. Its first store opened in 1963, and its headquarters are in Woonsocket, Rhode Island.

Company size
10,001+
Company stage
IPO
Headquarters
Woonsocket, Rhode Island
Founded
1963

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