Analyst, Case Management – Field – Must reside in Winnebago County Illinois at CVS Health

Rockford, Illinois, United States

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Not SpecifiedCompensation

Junior (1 to 2 years), Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Must reside in Winnebago County, IL or surrounding areas
Case management experience
Microsoft Office and electronic health record experience
Valid Illinois Driver’s license
Willing and able to travel up to 75% of time to meet with members face to face
Reliable transportation required (eligible for mileage reimbursement per company policy)
Bachelor’s degree or a non-licensed individual with a master’s degree, with either degree in a human-services field (including, but not limited to sociology, special education, rehabilitation counseling)

Responsibilities

Conduct comprehensive evaluation of referred members' needs/eligibility using care management tools and data review, recommend approach to case resolution by evaluating benefit plan and available programs/services
Identify high risk factors and service needs impacting member outcomes and care planning, with appropriate referral to clinical case management or crisis intervention
Coordinate and implement assigned care plan activities and monitor care plan progress
Consult with case managers, supervisors, Medical Directors, and/or other health programs using a holistic approach to overcome barriers to goals; present cases at case conferences for multidisciplinary review to achieve optimal outcomes
Identify and escalate quality of care issues through established channels
Utilize negotiation skills to secure appropriate options and services necessary to meet member’s benefits and/or healthcare needs
Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes for optimum health
Provide coaching, information, and support to empower members to make ongoing independent medical and/or healthy lifestyle choices
Help members actively and knowledgeably participate with their provider in healthcare decision-making
Utilize case management and quality management processes in compliance with regulatory, accreditation guidelines, and company policies/procedures
Manage a full caseload of waiver members, including in-person quarterly visits

Skills

Case Management

Care Coordination

LTSS

Healthcare Outcomes

Member Evaluation

Care Planning

Risk Assessment

Crisis Intervention

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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