Case Management Analyst – 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.

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

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

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

• Coordinate and execute designated care plan activities while monitoring progress.

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

• Present cases during case conferences for multidisciplinary evaluation.

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

• Negotiate suitable options and services to fulfill members’ healthcare needs and benefits.

• Employ influencing and motivational interviewing techniques to enhance member engagement and encourage healthy behavior changes.

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

• 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 facilities, group homes, shelters, and detention centers in central West Virginia.

⛳️ Requirements

• Minimum of 2 years’ experience in behavioral health, social services, or a relevant related field aligned with the program focus.

• Residency in West Virginia, specifically in Braxton, Calhoun, Clay, Fayette, Gilmer, Kanawha, Nicholas, Roane, or Webster-Regional county.

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

• Over 2 years of experience with personal computers, including keyboard, mouse, multi-system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams).

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

• Preferred experience with Medicaid.

• Preferred experience with waivers.

• 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.

• Standard business hours are Monday-Friday; no nights, weekends, or holidays required.

• Direct/hardwired internet connection within 7 feet of the modem/router, with minimum speeds of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not acceptable.

• A quiet, secure, and private designated home workspace that complies with CVS Health and HIPAA guidelines is necessary.

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

• Must supply own workspace furniture.

• Ability to achieve required internet speeds and adhere to Work From Home criteria.

• Comfort in setting up and utilizing multiple monitors while navigating various applications.

• Proficiency in using email, calendar invites, Teams messaging, and virtual meetings.

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

• Ability to access secure systems such as VPN and EHR portals, follow computer security protocols, manage strong passwords, and recognize suspicious emails or links.

• Capability to independently troubleshoot common technical issues.

• Willingness to learn new skills.

🏝️ Benefits

• Mileage reimbursement according to company expense reimbursement policy.

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

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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