Analyst, Case Management

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Program Summary:

Join our Aetna care management team as we lead the way in providing exceptional care to dual eligible populations You will have a life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in both Medicare and Medicaid. As a member of the care team, you will collaborate with members, the internal care team, healthcare providers, and community organizations to meet the complex healthcare and social needs of our members Be part of this exciting opportunity as we expand our DSNP services to transform lives in new markets across the country.

Position Summary/Mission:

As a vital member of our Special Needs Plan (SNP) care team, the Care Coordinator (CC) is responsible for coordinating care for our members through close collaboration with the Care Manager, Social Worker, and other interdisciplinary team members. This role involves evaluating member needs through the annual Health Risk Survey, addressing social determinants of health (SDoH), coordinating care across the continuum, and closing gaps in preventive and health maintenance care.

Key Responsibilities:

• Member Evaluation: Conduct the annual Health Risk Survey to support needs identification for the member's Individual Plan of Care.
• Risk Escalation: Inform the assigned care manager of newly identified health/safety risks or service needs
• Care Coordination: Complete care coordination activities delegated by the care manager within an established timeframe.
• Quality Issue Escalation: inform the assigned care manager and/or associate manager of any identified quality of care issues.
• Advocacy: Passionately support the member's care coordination needs and drive solutions to address those needs.
• Member Engagement: Use problem-solving skills to find alternative contact information for members who are unreachable by care management. Employ motivational interviewing techniques to maximize member engagement and promote lifestyle changes for optimal health.
• Monitoring and Documentation: Adhere to case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies.

Essential Competencies and Functions:

• Meet performance and productivity metrics, including call volume, successful member engagement, and compliance with state/federal regulatory requirements.
• Conduct oneself with integrity, professionalism, and self-direction.
• Demonstrate a willingness to learn about care management within Medicare and Medicaid managed care.
• Familiarity with community resources and services.
• Navigate various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
• Maintain strong collaborative and professional relationships with members and colleagues.
• Communicate effectively, both verbally and in writing.
• Exhibit excellent customer service and engagement skills.

Required Qualifications

• 2+ years in behavioral health, social services, or a related field relevant to the program focus
  • Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and capable of utilizing these tools effectively in the CM Coordinator role.
  • Access to a private, dedicated workspace to fulfill job requirements effectively.

Preferred Qualifications

• Case Management and Discharge Planning Experience
• Managed Care Experience

Education

• High School Diploma with equivalent experience (REQUIRED)
• Associate's or Bachelor's Degree or non-licensed master's level clinician in behavioral health or human services (psychology, social work, marriage and family therapy, counseling) or equivalent experience (PREFERRED)

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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