Analyst, Case Management

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Perform thorough assessments of referred members' needs and eligibility utilizing care management tools and data analysis.

• Suggest case-resolution strategies and assess benefit plans along with internal and external programs/services.

• Recognize high-risk factors and service requirements, making suitable referrals to clinical case management or crisis intervention.

• Coordinate and execute assigned care-plan activities while monitoring progress.

• Collaborate with case managers, supervisors, Medical Directors, and other health programs to address barriers.

• Present cases at interdisciplinary conferences for collaborative review.

• Identify and escalate quality-of-care concerns through the proper channels.

• Negotiate suitable options and services to fulfill members' benefits and healthcare requirements.

• Utilize influencing and motivational interviewing techniques to engage members and encourage healthy lifestyle changes.

• Offer coaching, information, and support to empower members in their healthcare and lifestyle choices.

• Assist members in participating knowledgeably in healthcare decision-making alongside providers.

• Implement case-management and quality-management processes in accordance with regulatory, accreditation, and company standards.

• Manage a complete caseload of waiver members and conduct necessary in-person quarterly visits.

⛳️ Requirements

• Must reside in the Macon County area of Illinois.

• Valid Illinois Driver’s license required.

• Willingness and ability to travel up to 75% of the time for face-to-face meetings with members.

• Reliable transportation is necessary; eligible for mileage reimbursement according to company policy.

• Minimum of two (2) years of experience in case management.

• Proficient in Microsoft Office and electronic health records.

• Experience in case management and discharge planning is preferred.

• Preferred experience in Managed Care.

• Preferred familiarity with Microsoft Office.

• Bachelor’s degree or a non-licensed individual with a master’s degree in a human-services field, such as sociology, special education, or rehabilitation counseling.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• Mileage reimbursement according to company policy.

• Eligibility for CVS Health bonus, commission, or short-term incentive program in addition to base pay.