Care Management Analyst

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

📋 Description

• Evaluate and prioritize tasks for the Care Team.

• Determine reasons for admissions, facilities, and member products to utilize intervention assessment tools.

• Assess patients according to intervention business rules and procedures.

• Identify necessary medical services, provide referrals, and coordinate essential services in line with the benefit plan.

• Oversee non-targeted cases to ensure appropriate discharge dates and outcomes.

• Recognize and refer outlier cases to clinical personnel.

• Detect triggers for referrals into Case Management, Disease Management, and Mixed Services.

• Aid in the creation and execution of care plans.

• Organize and coordinate healthcare service delivery under the guidance of a nurse or medical director.

• Identify opportunities to utilize participating providers and services in suitable settings and at reasonable costs.

• Foster communication with healthcare providers and team members, both internally and externally.

• Conduct non-medical research for establishing, managing, and closing open cases.

• Handle telephone calls, take messages, research information, and assist in problem resolution.

• Maintain precise documentation that meets risk management, regulatory, and accreditation standards.

• Safeguard member confidentiality and adhere to company confidentiality protocols.

• Assist in investigating and resolving claims payment discrepancies.

• Support hospital care, case management, and quality management processes in accordance with relevant laws, regulations, URAQ, NCQA, CMSA standards, and company policies.

⛳️ Requirements

• At least 1–3+ years of experience in a medical assistant, office assistant, or a related healthcare/medical position.

• Exceptional customer service abilities.

• Attentiveness to members and providers.

• Sensitivity to various issues.

• Proactive in identifying and resolving issues.

• Experience in a medical office is preferred.

• Medicaid experience is preferred.

• Customer service experience is preferred.

• Experience in care coordination is preferred.

• Technical skills are preferred.

• High School diploma, G.E.D., or equivalent experience is required.

🏝️ Benefits

• Comprehensive benefits package.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Eligibility for CVS Health bonus, commission, or short-term incentive program.