Case Management Analyst – Field

CVS Health

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

Posted 10/15/2026full-timeRemote • United StatesJuniorMid-Level💰 $21 - $37 per hourWebsite

About the role

Key responsibilities & impact

Conduct comprehensive evaluations of referred members’ needs and eligibility using care management tools and data review
Recommend case-resolution approaches by evaluating benefit plans and internal and external programs/services
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 promote member engagement and healthy behavior changes
Provide coaching, information, and support for 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 requirements
Travel to member homes, residential treatment facilities, group homes, shelters, and detention facilities in central West Virginia

Requirements

What you’ll need

2 years’ experience in behavioral health, social services, or an appropriate related field equivalent to the program focus
West Virginia residency, residing in Braxton, Calhoun, Clay, Fayette, Gilmer, Kanawha, Nicholas, Roane, or Webster-Regional county
Reliable transportation and willingness and ability to travel 50% or more in the assigned region
2+ years of experience with personal computers, 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
Monday-Friday standard business hours; no nights, weekends, or holidays
Direct/hardwired internet connection within 7 feet of the modem/router, with minimum 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not permitted
Quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently residing
Must provide own workspace furniture
Ability to obtain required internet speeds and comply with Work From Home requirements
Comfort setting up and using multiple monitors and navigating multiple applications
Ability to use 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, follow computer security practices, manage strong passwords, and recognize suspicious emails or links
Ability to troubleshoot common technical issues independently
Openness to learning new skills

Benefits

Comp & perks

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