Analyst, Case Management – Field

CVS Health

. Conduct comprehensive evaluations of referred members’ needs and eligibility using care management tools and data review .

Posted 10/28/2026full-timeRemote • United StatesJuniorMid-Level💰 $21 - $37 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management and quality management processes, with a strong focus on behavioral health and social services. Proficient in utilizing care management tools and data analysis to enhance member outcomes and ensure compliance with regulatory standards.

Highest-signal resume keywords

Case Management ExperienceBehavioral Health ExpertiseCrisis Intervention SkillsMedicaid ExperienceMS Office Suite Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementCrisis InterventionBehavioral Health EvaluationQuality Management ProcessesData ReviewBenefit Plan EvaluationMulti-System NavigationCoaching and SupportMotivational InterviewingDischarge Planning

Soft Skills

Communication SkillsInfluencing SkillsProblem-Solving SkillsTeam CollaborationEmpathy

Tools & Technologies

MS Office SuiteQuickBaseVPNEHR PortalsMicrosoft Office 365Google Workspace

Industry Keywords

Managed CareUtilization ReviewFoster CareWaiver ProgramsHIPAA Compliance

About the role

Key responsibilities & impact

Conduct comprehensive evaluations of referred members’ needs and eligibility using care management tools and data review
Evaluate benefit plans and internal and external programs/services to recommend case resolution approaches
Identify high-risk factors and service needs affecting member outcomes and care planning
Refer members to clinical case management or crisis intervention when appropriate
Coordinate and implement assigned care plan activities and monitor progress
Consult with case managers, supervisors, Medical Directors, and other health programs to overcome barriers
Present cases at case conferences for multidisciplinary review
Identify and escalate quality-of-care issues through established channels
Negotiate appropriate options and services to meet members’ benefits and healthcare needs
Use influencing and motivational interviewing skills to engage members and promote lifestyle/behavior changes
Provide coaching, information, and support to empower members’ independent medical and healthy-lifestyle choices
Help members participate knowledgeably in healthcare decision-making with providers
Apply case management and quality management processes in compliance with regulatory, accreditation, and company guidelines
Travel to member homes, residential treatment facilities, group homes, shelters, and detention facilities in Northern West Virginia

Requirements

What you’ll need

2 years’ experience in behavioral health, social services, or an appropriate related field equivalent to program focus
West Virginia residency in one of the following counties: Barbour, Brooke, Doddridge, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Ritchie, Taylor, Tyler, Upshur, or Wetzel
Reliable transportation and willingness and ability to travel in the assigned region 50% or more of the time
2+ years of experience with personal computer, 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; degree in behavioral health or human services preferred
Medicaid experience preferred
Waiver experience preferred
Foster care experience preferred
Crisis intervention skills preferred
Managed care/utilization review experience preferred
Case management and discharge planning experience preferred
Familiarity with QuickBase preferred
Direct/hardwired internet connection to a modem/router within 7 feet of the computer, with minimum 25 Mbps download and 3 Mbps upload speeds
WiFi and satellite internet are not permitted
Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently living
Must provide own workspace furniture
Ability to use multiple monitors and navigate multiple applications simultaneously
Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
Experience with Microsoft Office 365 or similar Google Workspace applications
Ability to log in to secure systems such as VPN and EHR portals, secure devices, manage strong passwords, and recognize suspicious emails or links
Ability to troubleshoot common technical issues independently
Openness to learning new skills as the workplace evolves

Benefits

Comp & perks

Mileage is reimbursed per company expense reimbursement policy
Company-provided equipment (keyboard, monitor, computer, headset, etc.)
Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being