Case Management Analyst
Company: CVS Pharmacy
Location: Charleston
Posted on: June 23, 2022
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Job Description:
Job DescriptionSchedule is Monday-Friday standard business
hours. No nights, no weekends and no holidays. This is a full-time
telework role open to candidates in the Central Region of WV, with
up to 20% travel required within the assigned region. Candidates
must be located in one of the following counties in WV: Kanawha,
Clay, Braxton, Gilmer, Fayette, Nicholas, Roane, Calhoun, or
Webster. Utilizes critical thinking and judgment to collaborate and
inform the case management process, in order to facilitate
appropriate healthcare outcomes for members by providing care
coordination, support and education for members through the use of
care management tools and resources.Utilizes critical thinking and
judgment to collaborate and inform the case management process, in
order to facilitate appropriate healthcare outcomes for members by
providing care coordination, support and education for members
through the use of care management tools and resources.Schedule is
Monday-Friday standard business hours. No nights, no weekends and
no holidays. Evaluation of Members:-Through the use of care
management tools and information/data review, conducts
comprehensive evaluation of referred member's needs/eligibility and
recommends an approach to case resolution and/or meeting needs 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 care planning
components with appropriate referral to clinical case management or
crisis intervention as appropriate. - Coordinates and implements
assigned care plan activities and monitors care plan
progress.Enhancement of Medical Appropriateness and Quality of
Care:- 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.Monitoring, Evaluation and Documentation of Care:-
Utilizes case management and quality management processes in
compliance with regulatory and accreditation guidelines and company
policies and procedures.Required Qualifications- 2+ years of
experience in behavioral health or social services- West Virginia
resident required- 1+ year(s) of experience with computer skills,
which includes navigating multiple systems, keyboarding, and
Microsoft OfficeCOVID RequirementsCOVID-19 Vaccination
RequirementCVS Health requires certain colleagues to be fully
vaccinated against COVID-19 (including any booster shots if
required), where allowable under the law, unless they are approved
for a reasonable accommodation based on disability, medical
condition, religious belief, or other legally recognized reasons
that prevents them from being vaccinated. You are required to have
received at least one COVID-19 shot prior to your first day of
employment and to provide proof of your vaccination status or apply
for a reasonable accommodation within the first 10 days of your
employment. Please note that in some states and roles, you may be
required to provide proof of full vaccination or an approved
reasonable accommodation before you can begin to actively
work.Preferred Qualifications- Foster care experience, pediatrics,
school nursing, or PICU/NICU experience- Case management and
discharge planning experience - Managed care experienceEducation-
Bachelor's degree or non-licensed master level clinician required,
with either degree being in behavioral health or human services
preferred (psychology, social work, marriage and family therapy,
counseling).Business OverviewBring your heart to CVS HealthEvery
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. We strive to promote and sustain a culture of
diversity, inclusion and belonging every day. CVS Health is an
affirmative action employer, and is an equal opportunity employer,
as are the physician-owned businesses for which CVS Health provides
management services. 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.
Keywords: CVS Pharmacy, Charleston , Case Management Analyst, Executive , Charleston, West Virginia
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