Analyst, Case Management Specialist

2 weeks ago

Hamilton, United States CVS Health Full time

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Program Overview

Help us elevate our patient care to a whole new level Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the state.

Position Summary/Mission

The Case Management Analyst facilitates appropriate healthcare outcomes for members by locating and establishing communication with members that have not been reached and engaged in active care management. The Analyst will make all efforts to outreach and locate members that are currently unable to reach, after locating these members the analyst will coordinate with the member.

The analyst will identify members initial needs and will manage the member or assign the member to an appropriate care manager.

Fundamental Components

• Engaging Members: Using care management tools and information/data review, conducts ongoing face to face and telephonic outreach to locate and engage unreached members.

• Identifies and coordinates members’ initial nonclinical service needs (DME, transportation, etc.) in coordination with a Transdisciplinary Care Team (TDC).

• 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.

• Documentation of Care: Utilizes case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

  • Must reside in one of the following Ohio counties: Butler, Warren, Clinton, Clermont, or Hamilton

  • 2 years’ LPN experience or in behavioral or physical health, social services, or appropriate related field equivalent to program focus

  • Ability to travel up to 75% within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise

  • Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.

  • Excellent analytical and problem-solving skills.

  • Effective communications, organizational, and interpersonal skills.

  • Ability to work independently to meet productivity requirements.

  • Ability to positively adapt and implement frequent process changes.

  • Efficient and Effective computer skills including navigating multiple systems and keyboarding.

Preferred Requirements

  • 2+ years experience working in the community, visiting members’ homes and working virtually using tools to collaborate and connect with teams virtually.

  • Case management/ Managed care experience preferred.

Education

  • LPN or bachelor’s degree in behavioral health or health care related field (psychology, social work, counseling, nutrition, PT or OT Assistant etc.

Pay Range

The typical pay range for this role is:

$21.10 - $36.78

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 09/24/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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