Analyst, Case Management - OhioRISE - Must reside in the Northeast Region of OH at CVS Health

Cincinnati, Ohio, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Medicaid Managed CareIndustries

Requirements

Must reside in the Northeast region of Ohio (strongly prefers Stark, Columbiana, Belmont, Jefferson, Marion, or Ottawa County)
Ability to travel within assigned region of Northeast Ohio to member homes and other locations, up to 50% or more of the time
Clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems
Full-time availability Monday-Friday 8-5pm with flexibility to work later to meet member needs
Field-based telework position in Ohio

Responsibilities

Conduct comprehensive evaluation of referred member's needs/eligibility using care management tools and data review, recommend approach to case resolution, identify high risk factors and service needs, and refer to clinical case management or crisis intervention as appropriate
Coordinate and implement assigned care plan activities and monitor care plan progress
Consult with case managers, supervisors, Medical Directors, and other programs using a holistic approach to overcome barriers, present cases at conferences for multidisciplinary review, and achieve optimal outcomes
Work collaboratively with members' Child and Family Teams
Identify and escalate quality of care issues through established channels
Utilize negotiation skills to secure appropriate options and services to meet member's benefits and healthcare needs
Use influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes
Provide coaching, information, and support to empower members to make independent medical and healthy lifestyle choices
Help members actively participate with providers in healthcare decision-making
Serve as a single point of contact for members and assist in remediating immediate and acute gaps in care and access
Utilize critical thinking and judgment to collaborate and inform the case management process for appropriate healthcare outcomes, providing care coordination, support, and education using care management tools and resources

Skills

Key technologies and capabilities for this role

Case ManagementCare CoordinationBehavioral HealthCritical ThinkingHealthcare OutcomesMember SupportOhio Medicaid

Questions & Answers

Common questions about this position

What is the work arrangement for this position?

This is a full-time field-based telework position in Ohio requiring up to 50% or more travel within the Northeast region to member homes and other locations, with standard hours Monday-Friday 8-5pm and flexibility to work later as needed.

Where must applicants reside for this role?

Applicants must reside in the Northeast region of Ohio, with strong preference for candidates in Stark, Columbiana, Belmont, Jefferson, Marion, or Ottawa County.

What key skills are required for the Case Management Coordinator role?

Candidates need clinical and cultural competence/responsiveness with training and experience to manage complex cases in the community across child-serving systems, critical thinking and judgment for care coordination, and the ability to conduct comprehensive member evaluations using care management tools.

What is the salary or compensation for this position?

This information is not specified in the job description.

What makes a strong candidate for this Analyst role?

Strong candidates will have clinical and cultural competence with experience managing complex community cases across child-serving systems, the ability to travel up to 50% in Northeast Ohio, and skills in care coordination, member evaluation, and implementing care plans.

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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