Analyst, Case Management

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

📋 Description

• Facilitate effective healthcare outcomes for waiver/LTSS members through coordination of care, support, and educational initiatives.

• Conduct thorough assessments of referred members’ needs and eligibility criteria.

• Suggest case-resolution strategies by analyzing benefit plans and various internal and external programs/services.

• Identify high-risk factors and service requirements that impact member outcomes and care planning.

• Refer members to clinical case management or crisis intervention services when necessary.

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

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

• Present cases during multidisciplinary case conferences for comprehensive review.

• Recognize and escalate quality-of-care concerns as needed.

• Negotiate suitable options and services to fulfill members’ benefit and healthcare requirements.

• Employ influencing and motivational interviewing techniques to engage members and encourage lifestyle or behavioral modifications.

• Offer coaching, information, and support for independent medical and healthy lifestyle choices.

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

• Implement case-management and quality-management processes adhering to regulatory, accreditation, and company standards.

• Travel 50–75% of the time and conduct in-person member visits quarterly.

⛳️ Requirements

• Must reside in the Rock Island area of Illinois.

• A valid Illinois Driver’s license is required.

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

• Reliable transportation is necessary.

• A minimum of two (2) years of experience in case management is required.

• Proficiency in Microsoft Office and electronic health record systems.

• If managing HIV/AIDS HCBS Waiver members: experience with racial and ethnic minorities and one or more of the following: domestic abuse, the LGBTQ+ community, individuals living with HIV/AIDS, or individuals with substance use disorders.

• Experience in case management and discharge planning is preferred.

• Managed Care experience is a plus.

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

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Mileage reimbursement in accordance with company policy.