Analyst, Case Management- Field (Will County) at CVS Health

Mokena, Illinois, United States

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Case management and discharge planning experience preferred
2 years experience in behavioral health, social services or appropriate related field equivalent to program focus
Managed Care experience preferred
Confidence working at home/independently (inferred from WFH/field role with up to 50% travel in Will County)

Responsibilities

Conducts comprehensive evaluation of member’s needs/eligibility using care management tools and data review, recommends approach to case resolution by evaluating benefit plan and available programs/services
Identifies high risk factors and service needs impacting member outcomes, refers to clinical case management or crisis intervention as appropriate
Coordinates and implements assigned care plan activities and monitors care plan progress
Consults with case managers, supervisors, Medical Directors and/or other health programs using holistic approach to overcome barriers to goals; presents cases at case conferences for multidisciplinary review to achieve optimal outcomes
Identifies and escalates quality of care issues through established channels
Utilizes negotiation skills to secure appropriate options and services to meet member’s benefits and/or healthcare needs
Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes for optimum health
Provides coaching, information and support to empower members to make independent medical and healthy lifestyle choices
Engages with colleagues in ongoing team meetings and offers peer mentoring/training
Helps members actively and knowledgably participate with their provider in healthcare decision-making
Utilizes case management and quality management processes in compliance with regulatory, accreditation guidelines, and company policies/procedures
Facilitates appropriate healthcare outcomes by assisting with appointment scheduling, identifying and assisting with accessing benefits, and providing education using care management tools and resources

Skills

Case Management

Care Management Tools

Member Evaluation

Appointment Scheduling

Benefits Access

Healthcare Outcomes

Critical Thinking

Data Review

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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