At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

*Must be able to travel within the following Ohio counties: Fulton, Lucas, Ottawa, Wood.

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the state.

The Case Management Analyst facilitates appropriate healthcare outcomes for members by locating and establishing communication with members that have not been reached and engaged in active care management. The Analyst will make all efforts to outreach and locate members that are currently unable to reach, after locating these members the analyst will coordinate with the member. The analyst will identify members initial needs and will manage the member or assign the member to an appropriate care manager.

Additional Responsibilities include but not limited to the following:

- Engaging Members: Using care management tools and information/data review, conducts ongoing face to face and telephonic outreach to locate and engage unreached members.

- Identifies and coordinates members’ initial nonclinical service needs (DME, transportation, etc.) in coordination with a Transdisciplinary Care Team (TDC).

- Identifies and escalates quality of care issues through established channels.

- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.

- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.

- Documentation of Care: Utilizes case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

- Must be able to travel within the following Ohio counties: Fulton, Lucas, Ottawa, Wood.

- 2 years experience as a Licensed Practical Nurse or in Behavioral or physical health, Social Services, or related field.

- Ability to travel up to 75% within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise

- Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.

- Excellent analytical and problem-solving skills.

- Effective communications, organizational, and interpersonal skills.

- Ability to work independently to meet productivity requirements.

- Ability to positively adapt and implement frequent process changes.

- Efficient and Effective computer skills including navigating multiple systems and keyboarding.

Preferred Qualifications

- 2 years experience working in the community, visiting members’ homes and working virtually using tools to collaborate and connect with teams virtually.

- Case management/ Managed care experience preferred.

- Bachelor’s Degree in Behavioral Health or Healthcare related field (Psychology, Social Work, Counseling, Nutrition, Physical Therapy or Occupational Therapy Assistant, ETC.)

Education

Licensed Practical Nurse

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.