Analyst, Case Management

CVS Health • Remote (AZ, United States) • $200k - $250k / year • 6d ago

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

SIGN ON BONUS - Qualifying candidates may be eligible for up to a $5,000 sign on bonus upon hire.

Starting salary for this role is $31.25/$65,000.

This role is work from home with travel required in Maricopa County, Arizona to visit members. Qualified candidates must live in West Maricopa County, Central/West Phoenix, Surprise, Glendale, Peoria, Buckeye, Wickenburg, Gila Bend, Anthem/New River, or surrounding areas.

Responsibilities:

Utilizes skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria 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 referrals.
Coordinates and implements assigned care plan activities and monitors care plan progress.
Uses a holistic approach to overcome barriers to meet 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 knowledgably participate with their provider in healthcare decision-making.
Utilizes case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

2+ years of Case Management experience working with people who have been designated as having a serious mental illness (SMI) and working with people who are elderly or have a physical disability.
Qualified candidates must live in West Maricopa County, Central/West Phoenix, Surprise, Glendale, Peoria, Buckeye, Wickenburg, Gila Bend, Anthem/New River, or surrounding areas.
Reliable transportation required (Mileage is reimbursed per our company expense reimbursement policy).

Preferred Qualifications

Computer proficient with Outlook, Windows, and Word.
Experience collaborating with medical professionals.
Critical areas to succeed- organization, collaboration, and time management.

Education

Candidates must have earned a 4-year bachelor’s degree, preferred in social work, psychology, special education, or counseling.

Pay Range

The typical pay range for this role is: $19.52 - $40.90. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors.

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions.

We anticipate the application window for this opening will close on: 04/30/2024.

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