Full-Time

Analyst – Case Management

Posted on 11/27/2024

CVS Pharmacy

CVS Pharmacy

10,001+ employees

Retail pharmacy and healthcare services provider

Healthcare
Consumer Goods

Compensation Overview

$21.1 - $44.99Hourly

+ Bonus + Commission + Short-term Incentive Program

Junior, Mid

Company Historically Provides H1B Sponsorship

Remote in USA

Category
Healthcare Administration & Support
Medical, Clinical & Veterinary
Requirements
  • Minimum 2 years of experience in behavioral health, social services or human services field
  • Minimum 2 years of case Management experience
  • Willing and able to travel 50-75% of the time to meet members face to face
  • 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)
Responsibilities
  • facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources
  • 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
  • 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 in order 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 knowledgeably participate with their provider in healthcare decision-making
  • Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, beauty items, and general merchandise. CVS Health also functions as a pharmacy benefits manager, serving over 75 million plan members, and has a senior pharmacy care business that assists more than one million patients each year. This integrated model allows CVS Health to deliver affordable health management solutions, improving access to quality care and health outcomes while aiming to reduce overall healthcare costs. Unlike many competitors, CVS Health combines retail pharmacy services with clinical care and pharmacy benefits management, positioning itself as a significant player in the healthcare sector with a commitment to enhancing people's health.

Company Stage

Debt Financing

Total Funding

N/A

Headquarters

Woonsocket, Rhode Island

Founded

N/A

Growth & Insights
Headcount

6 month growth

-2%

1 year growth

-2%

2 year growth

-2%
Simplify Jobs

Simplify's Take

What believers are saying

  • The availability of updated flu and COVID-19 vaccines at CVS Pharmacy and MinuteClinic locations nationwide positions the company as a key player in public health initiatives.
  • The Health Zones funding and collaboration with local organizations in Fresno highlight CVS Pharmacy's role in improving community health outcomes.
  • The introduction of a new store brand for snacks, beverages, and groceries could attract a broader customer base and increase in-store sales.

What critics are saying

  • The competitive landscape in the retail pharmacy sector is intense, with major players like Walgreens and Rite Aid posing significant challenges.
  • The expansion into grocery and snack products may dilute CVS Pharmacy's brand identity as a healthcare provider.

What makes CVS Pharmacy unique

  • CVS Pharmacy's integration of digital tools for scheduling vaccinations and accepting walk-ins offers a seamless and convenient experience for customers, setting it apart from competitors.
  • The company's Health Zones initiative, which focuses on community health and access to healthy food, demonstrates a commitment to social responsibility that goes beyond traditional pharmacy services.
  • CVS Pharmacy's recent launch of a new store brand for snacks, beverages, and groceries diversifies its product offerings, making it a one-stop shop for consumers.

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