Analyst, Case Management, Field

About the role

We're building a world of health around every individual. As a Summary Care Management Coordinator (CMC) at CVS Health, you'll play a key role in shaping a more connected, convenient, and compassionate health experience. Your responsibilities include assessing, planning, implementing, coordinating, monitoring, and evaluating care management and care coordination activities. You'll collaborate with interdisciplinary teams to ensure appropriate healthcare outcomes for assigned members.

Responsibilities

• Uses care management tools and information to complete a comprehensive evaluation of members and recommends an approach to case resolution by determining member needs in alignment with their benefit plan and available internal and external programs and services.
• Identifies high risk factors and service needs that may impact member outcomes and care planning with appropriate referral to clinical case management or crisis intervention as appropriate.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve an 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.
• Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access.
• Collaborates with the interdisciplinary care team to develop and monitor established plans of care to meet the member’s goals.
• Identifies and escalates quality of care issues through established channels.
• Maintains care utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Identifies, refers, and links members to providers and social supports as needed (e.g., scheduling appointments, arranging transportation).
• Edits members about available resources and services such as Texas value-added benefits and assists the member in accessing those resources and services.
• Facilitates clinical hand-offs during transitions of care.

Requirements

• Minimum of 2 years of experience in care management, rehabilitation services, health services, social services coordination, or behavioral health.
• Strong assessment, care coordination, and care planning skills.
• Effective communication and collaboration skills with members, providers, and interdisciplinary teams.
• Willingness and ability to travel 10-20% locally for member visits; reliable transportation required.
• Ability to work remotely and meet work-from-home and technology requirements.
• Ability to work two evenings per week until 9:00 PM.

Preferred Qualifications

• Case management and discharge planning experience.
• Managed care experience.
• Experience supporting maternity populations.
• Knowledge of community resources and social service programs.
• Experience working within interdisciplinary healthcare teams.

Qualifications

• Bachelor's degree in Social Work, Psychology, Human Services, Counseling, Sociology, or a related social services field.
• Licensed Behavioral Health Professional in the State of Texas, as applicable to role requirements.

Benefits

The typical pay range for this role is $21.10 - $40.90. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members, and communities we serve and we are committed to fostering a workplace where every colleague feels valued and belongs. Great benefits for great people. We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.