Home
/
Comprehensive
/
Analyst, Case Management - TOC
Analyst, Case Management - TOC-March 2024
Work At Home
Mar 18, 2025
ABOUT CVS HEALTH
CVS Health is a healthcare innovation company. Together, we are helping people on their path to better health.
10,000+ employees
Healthcare
VIEW COMPANY PROFILE >>
About Analyst, Case Management - TOC

  Bring your heart to CVS Health. Every 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.

  Position SummaryThank you for your interest in furthering your career with CVS Health. This site is dedicated to hosting all CVS Health openings across the enterprise, and is only available to our internal colleagues. Here you can search openings, maintain your internal candidate profile, upload resumes, and set up a search agent for newly posted jobs that match your search criteria. We encourage you to discuss your career goals and interest in a new role with your leader. Should you be considered for a new role, a notification still be sent to your current leader during the selection process. Note: If you are a contractor or external consultant and have reached this page, please logout of this internal employee Career Site and apply via the CVS Careers Page. This is a full-time telework position open to candidates in the United States. Schedule for this position is Monday-Friday 8:00a-5:00p EST. Program Overview: Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have lifechanging impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country. Position Summary/Mission: The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources.

  Fundamental Components

  • 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 experience in behavioral health or social services

  • Must have the ability to work 8:00a-5:00p EST

  • 2+ years of experience with Microsoft Office applications (Word, Excel, Outlook)Preferred Qualifications• Case management and discharge planning experience

  • Managed Care experienceEducation

  Bachelor's degree or non-licensed master level clinician with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling) or equivalent experience.

  Pay Range

  The typical pay range for this role is:

  $19.52 - $40.90

  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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

  CVS 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.

  CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through [email protected] If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.

Comments
Welcome to zdrecruit comments! Please keep conversations courteous and on-topic. To fosterproductive and respectful conversations, you may see comments from our Community Managers.
Sign up to post
Sort by
Show More Comments
SIMILAR JOBS
Customer Service Representative
Compensation Range: $15.00 to $28.60 Hourly Location: 383 Grand Concourse, Bronx, New York 10451 United States of America Are you a people person? Do you love helping others? U-Haul is in search of f
RN - Chronic Dialysis
Initiation and discontinuation of dialysis via fistula, graft or central line. Assessment of patient, CL dressing changes, medication administration, and monitoring of the patients treatments. Requir
Crisis Management Representative
WARNING: Please beware of phishing scams that solicit interviews or promote work-at-home opportunities, some of which may pose as legitimate companies. Elevance Health requires a completed online app
Special Education Substitute Teacher
Substitute Teacher – Richmond County Georgia We are hiring for Substitute Teachers in Richmond County School System Remember that educator who made a difference in your life? Now it’s your turn! Subs
Pharmacy Claims Representative
...
Retail Maintenance
Req ID: 430131 Address: 1385 8th Ave SW Valley City, ND, 58072 Welcome to Love’s! Where People are the Heart of Our Success Retail Maintenance Maintenance Techs help run our business by keeping a saf
Diesel Technician Apprentice
Req ID: 430457 Address: 2050 Hwy 70 E. Jackson, TN, 38305 Welcome to Love’s! * * Where People are the Heart of Our Success * * Diesel Technician Apprentice - Truck Care At Love’s, our values go beyon
Executive Director for Principal Gifts
Executive Director for Principal Gifts Bookmark this Posting | Print Preview | Apply for this Job Please see Special Instructions for more details. Applicants must include in their online resume the
general warehouse
general warehouse. round rock , texas posted 1 day ago job details summary $19 per hour temporary category production occupations reference1010372-1 job details As a general Labor worker, clean and i
FOH Executive Assistant - CHS - Rockville, MD
STG International is seeking an Executive Assistant for Federal Occupational Health Services (FOH) in Rockville, MD The executive assistant provides high-level administrative, office, and project man
Copyright 2023-2025 - www.zdrecruit.com All Rights Reserved