Analyst, Case Management – Field

This is a fully remote position, open to applicants in Virginia, +1 more state.

📋 Description

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

• Analyze benefit plans and internal and external programs/services to suggest effective case resolution strategies.

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

• Make referrals to clinical case management or crisis intervention when deemed appropriate.

• 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 in multidisciplinary case conferences for comprehensive review.

• Recognize and escalate quality-of-care concerns through established procedures.

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

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

• Offer coaching, information, and support to empower members in making independent medical and healthy lifestyle choices.

• Assist members in making informed healthcare decisions with providers.

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

• Travel to member residences, residential treatment centers, group homes, shelters, and detention facilities in Northern West Virginia.

⛳️ Requirements

• Minimum of 2 years of experience in behavioral health, social services, or a related field equivalent to program focus.

• Residency in West Virginia within one of the following counties: Barbour, Brooke, Doddridge, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Ritchie, Taylor, Tyler, Upshur, or Wetzel.

• Reliable transportation with the ability and willingness to travel in the assigned region 50% or more of the time.

• Over 2 years of experience using personal computers, keyboard, mouse, navigating multiple systems, and applications in the MS Office Suite (Outlook, Word, Excel, SharePoint, Teams).

• A Bachelor's degree or a non-licensed master’s level clinician is required; a degree in behavioral health or human services is preferred.

• Preferred experience with Medicaid.

• Preferred experience in Waiver programs.

• Preferred experience in Foster care.

• Preferred crisis intervention skills.

• Preferred experience in managed care/utilization review.

• Preferred experience in case management and discharge planning.

• Familiarity with QuickBase is preferred.

• Direct/hardwired internet connection to a modem/router within 7 feet of the computer, with a minimum of 25 Mbps download and 3 Mbps upload speeds.

• WiFi and satellite internet connections are not permitted.

• A quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines.

• Must work within the state and city of current residence.

• Must provide own workspace furniture.

• Ability to utilize multiple monitors and navigate various applications simultaneously.

• Capacity to communicate through email, calendar invites, Teams messaging, and virtual meetings.

• Experience with Microsoft Office 365 or similar Google Workspace applications.

• Ability to access secure systems such as VPN and EHR portals, manage strong passwords, and identify suspicious emails or links.

• Capability to independently troubleshoot common technical issues.

• Willingness to learn new skills as the workplace evolves.

🏝️ Benefits

• Mileage reimbursement according to company expense reimbursement policy.

• Equipment provided by the company (keyboard, monitor, computer, headset, etc.).

• Coverage for medical, dental, and vision.

• Paid time off.

• Retirement savings options.

• Access to wellness programs.

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