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Analyst, Case Manager

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States , Springfield

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Category:
Customer Service

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Contract Type:
Employment contract

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Salary:

21.10 - 44.99 USD / Hour
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Job Description:

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Location: This is a full-time telework position requiring 50% travel in and around St Clair, Monroe, Madison, Bond and nearby counties in Illinois. Schedule: Standard business hours Monday-Friday 8:00am-5:00pm CST.

Job Responsibility:

  • Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of 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
  • Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives
  • 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
  • Engages with colleagues in ongoing team meetings and offers peer mentoring/training
  • Helps member actively and knowledgably participate with their provider in healthcare decision-making
  • Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Requirements:

  • 2+ years experience in Behavioral Health, Social Services or appropriate related field equivalent to program focus
  • Must be willing and able to travel 50% of the time in and around St Clair, Monroe, Madison, Bond counties in Illinois
  • Reliable transportation required
  • Must have 2+ years of experience of electronic documentation experience and Microsoft Office applications
  • Bachelor's degree or non-licensed master level clinician required with either degree being in Behavioral Health or Human Services (Psychology, Social Work, Marriage and Family therapy, Counseling)

Nice to have:

  • Demonstrates confidence working remotely as an independent thinker, with the ability to effectively use virtual tools to collaborate and stay connected with team members
  • Case management and discharge planning experience
  • Managed Care experience
What we offer:
  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • bonus, commission or short-term incentive program

Additional Information:

Job Posted:
May 15, 2026

Expiration:
June 05, 2026

Employment Type:
Fulltime
Work Type:
On-site work
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