Case Management Analyst, CVS Health

CVS Health

Location:
United States, Frankfort

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

21.10 - 36.78 USD / Hour

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Job Description:

Case Management Analyst role at CVS Health requires regional in-state travel across Kentucky with flexibility beyond core business hours. Works to improve healthcare outcomes through advocacy, collaboration, coordination, and education for members. Requires critical thinking and professional judgment to assess, address, and monitor members' healthcare needs.

Job Responsibility:

Through the use of care management assessments and information/data review, recommends an approach to resolving care needs maintaining optimal health and well-being 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 implements early and proactive support interventions
Coordinates and implements Wellness care plan activities and monitors member care needs
Using holistic approach 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 knowledgably 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

Requirements:

Minimum 6 months experience in Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services or evidence-based practices applicable to the Kentucky SKY populations
Minimum 2 year of experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling
Minimum 1 year of experience in MS Office Suite applications, including Word and Excel
Willing and able to travel 80-90% of their time to meet members face to face in their assigned region
Candidate must reside in one of the following counties: Breckinridge, Grayson, Meade, Hardin, Larue, Bullitt, Nelson, Marion, Washington, Spencer, Anderson, Woodford, Shelby, Franklin, Henry, Oldham, or Trimble

Nice to have:

3+ years' experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling
1+ MCO experience

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
employee stock purchase plan
No-cost programs including wellness screenings, tobacco cessation and weight management programs
confidential counseling
financial coaching
paid time off
flexible work schedules
family leave
dependent care resources
colleague assistance programs
tuition assistance
retiree medical access and other benefits depending on eligibility

Additional Information:

Job Posted:
May 14, 2025

Expiration:
June 30, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Case Management Analyst