Case Management Analyst - Field in Northern VA

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.

About the role

This Analyst, Case Management position is with Aetna’s Long-Term Services and Supports (LTSS) team and is a field-based role located in Northern Virginia (Annandale, Arlington, Falls Church, and/or Springfield). The role requires candidates to travel 75% of the time to meet with members face-to-face. The Case Management Analyst is responsible for assessing, planning, implementing, and coordinating case management activities with members to evaluate their medical needs and facilitate overall wellness. This includes developing proactive strategies to address member issues, enhancing short- and long-term outcomes, and integrating services to improve member wellness.

Through clinical tools and data review, the Analyst evaluates member needs, benefit plan eligibility, and facilitates transitions to Aetna programs. The role applies clinical judgment to reduce risk factors, address complex health and social indicators, and incorporate strategies for care planning. Assessments consider information from multiple sources, including co-morbid conditions and prior claims, to determine functionality and work capacity. The Analyst consults with supervisors and multidisciplinary teams to overcome barriers and ensure compliance with regulatory and company policies.

Work requires close inspection of documents, extended periods of sitting, telephone communication, travel to members' homes, and computer use.

Responsibilities

• Conduct face-to-face and telephonic assessments, planning, and coordination of case management activities to evaluate member needs and facilitate wellness.
• Develop proactive strategies to address member issues and enhance short- and long-term outcomes.
• Evaluate member needs and benefit plan eligibility using clinical tools and data review.
• Facilitate integrative functions and smooth transitions to Aetna programs.
• Apply clinical judgment to reduce risk factors and address complex health and social indicators impacting care planning.
• Assess member functionality, including work capacity and related restrictions/limitations, using a holistic approach.
• Review prior claims to address potential impacts on current case management and eligibility.
• Consult with supervisors and multidisciplinary teams to overcome barriers and present cases at case conferences.
• Ensure compliance with regulatory and company policies and procedures.
• Utilize interviewing skills to engage members and discern their health status and needs.

Requirements

• Candidate must reside in Annandale, Springfield, Falls Church, Arlington, or surrounding areas.
• 2 years’ experience in behavioral health, social services, or a related field.
• Reliable transportation and willingness to travel up to 75% of the time within the Central Region (mileage reimbursed).
• Bachelor's Degree or non-licensed master-level clinician in behavioral health or human services (e.g., psychology, social work, marriage and family therapy, counseling).

Preferred Qualifications

• Case management and discharge planning experience.
• Managed care experience.
• Qualified Mental Health Professional License (e.g., LMSW, LBSW, MSW, or BSW).

Schedule

• Monday–Friday, 8:00 AM–5:00 PM EST.
• Full-time, 40 hours per week.

Pay

The typical pay range for this role is $21.10–$40.90 per hour. The actual base salary offer will depend on factors such as experience, education, and geography. This position is also eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

Benefits

This full-time position is eligible for a comprehensive benefits package, including:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources.

Additional details about available benefits are provided during the application process.