Analyst, Case Management, Field

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Summary : Care Management Coordinators (CMC) drive and support care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating).  The CMC utilizes critical thinking and judgment to collaborate and inform the care management/care coordination process in order to facilitate appropriate healthcare outcomes for assigned members. They provide care coordination, support and education for members through the use of care management tools and resources.

Responsibilities: Uses care management tools and information to complete a comprehensive evaluation of members and recommends an approach to case resolution by determining member needs in alignment with their benefit plan and available internal and external programs and services. Identifies high risk factors and service needs that may impact member outcomes and care planning with appropriate referral to clinical case management or crisis intervention as appropriate. Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve an 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. Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access. Coordinates and implements assigned care plan activities and monitors care plan progress. Using a holistic approach consults with clinical care managers, leadership, medical directors and other physical/behavioral health support staff and providers to overcome barriers to meeting member goals and objectives. Presents cases at case conferences/rounds to obtain multidisciplinary review in order to achieve optimal outcomes. Works collaboratively with the members’ interdisciplinary care team. In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals. Identifies and escalates quality of care issues through established channels. Monitors, evaluates and documents care utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Identifies, refers, and links members to providers and social supports as needed (e.g., scheduling appointments, arranging transportation). Educates members about available resources and services such as Texas value-added benefits and assisting the member in accessing those resources and services. Facilitates clinical hand-offs during transitions of care. Willing and able to travel 10-20% of their time to meet members face to face in member service areas. Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policy.  Consistently meets defined performance and productivity standards. Ability to work two (2) evenings a week to 9pm Other duties as assigned. Work from Home Requirements:  • You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3mbs upload. WiFi and satellite internet are not permitted.  • A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized,