Case Management Analyst (Remote)

Program Summary

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.

Position Summary/Mission

As a vital member of our Special Needs Plan (SNP) care team, the Care Coordinator (CC) is responsible for coordinating care for our members through close collaboration with the Care Manager, Social Worker, and other interdisciplinary team members. This role involves evaluating member needs through the annual Health Risk Survey, addressing social determinants of health (SDoH), coordinating care across the continuum, and closing gaps in preventive and health maintenance care.

Key Responsibilities

• Member Evaluation: Conduct the annual Health Risk Survey to support needs identification for the member’s Individual Plan of Care.
• Risk Escalation: Inform the assigned care manager of newly identified health/safety risks or service needs.
• Care Coordination: Complete care coordination activities delegated by the care manager within an established timeframe.
• Quality Issue Escalation: inform the assigned care manager and/or associate manager of any identified quality of care issues.
• Advocacy: Passionately support the member’s care coordination needs and drive solutions to address those needs.
• Member Engagement: Use problem-solving skills to find alternative contact information for members who are unreachable by care management. Employ motivational interviewing techniques to maximize member engagement and promote lifestyle changes for optimal health.
• Misssion: Monitor and Documentation: Adhere to case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies.

Essential Competencies And Functions

• Meet performance and productivity metrics, including call volume, successful member engagement, and compliance with state/federal regulatory requirements.
• Conduct oneself with integrity, professionalism, and self-direction.
• Demonstrate a willingness to learn about care management within Medicare and Medicaid managed care.
• Familiarity with community resources and services.
• Navigate various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
• Maintain strong collaborative and professional relationships with members and colleagues.
• Communicate effectively, both verbally and in writing.
• Exhibit excellent customer service and engagement skills.

Required Qualifications

• 2+ years in behavioral health, social services, or a related field relevant to the program focus.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and capable of utilizing these tools effectively in the CM Coordinator role.
• Access to a private, dedicated workspace to fulfill job requirements effectively.

Preferred Qualifications

• Case Management and Discharge Planning Experience.
• Managed Care Experience.
• Eastern Time Education: High School Diploma with equivalent experience (REQUIRED).
• Associate’s or Bachelor’s Degree or non-licensed master’s level clinician in behavioral health or human services (psychology, social work, marriage and family therapy, counseling) or equivalent experience (PREFERRED).

Pay Range

The Typical Pay Range For This Role Is $21.10 - $44.99. 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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.