Analyst, Case Management - Field - Bloomingdale, Roselle, or Glendale Heights Illinois

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Position Summary

This position holds a full caseload to manage waiver members. Requires in-person quarterly visits with members. It is critical to meet contractual requirements and facilitate appropriate healthcare outcomes for waiver / LTSS members by providing care coordination, support and education through care management tools and resources.

Evaluation of Members

Through the use of care management tools and information / data review, conducts comprehensive evaluation of referred members’ needs / eligibility, recommends an approach to case resolution, and meets member needs by evaluating benefit plans and available internal aid and external programs / services. Identifies high risk factors and service needs that may impact member outcomes, with appropriate referral to clinical case management or crisis intervention. Coordinates and implements assigned care plan activities and monitors care plan progress.

Enhancement of Medical Appropriateness and Quality of Care

Using a holistic approach consults with case managers, supervisors, Medical Directors and other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes. 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 health. Provides coaching, information and support to empower the member to make ongoing independent medical and / or healthy lifestyle choices. Helps member actively and knowledgeably participate with their provider in healthcare decision‑making.

Monitoring, Evaluation and Documentation of Care

Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

A Brief Overview

Conducts routine care coordination, support, and education through the use of care management resources to facilitate appropriate healthcare outcomes for members. Applies practical knowledge of Case Management to administer best‑of‑class policies, procedures, and plans for the area.

What you will do

• Consult with case managers, supervisors, medical directors and other health programs using a holistic approach to overcome barriers to meeting goals and objectives.
• Present cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Identify and escalate quality of care issues through established channels.
• Demonstrate negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and / or healthcare needs.
• Deliver influencing / motivational interviewing skills to ensure maximum member engagement and promote lifestyle / behavior changes to achieve optimum level of health.
• Provide coaching, information, and support to empower the member to make ongoing independent medical and / or healthy lifestyle choices.
• Assist in encouraging members to actively participate with their provider in healthcare decision‑making.
• Conduct comprehensive evaluations of referred members’ needs / eligibility using care management tools and recommend an approach to case resolution.

Required Qualifications

Preferred Qualifications

Education

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is : $21.10 - $44.99. 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.

Great benefits for great people

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

We anticipate the application window for this opening will close on : 12 / 08 / 2025

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

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