Case Management Analyst

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

Candidates must reside in the following counties: Pikeville, Bowling Green/Owensboro, Paducah, Somerset/London 

• Consults with case managers, supervisors, medical directors and/or other health programs using a holistic approach.
• o  Presents cases at case conferences to obtain a multidisciplinary review in order to achieve optimal outcomes.
• o  Identifies and escalates quality of care issues through established channels.
• o  Demonstrates negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• o  Delivers influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• o  Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• o  Assists in encouraging members to actively participate with their provider in healthcare decision-making.
• o  Conducts comprehensive evaluations of referred members’ needs/eligibility using care management tools and recommends an approach to case resolution.

Required Qualifications

• Must reside in Kentucky in the following counties: Pikeville, Bowling Green/Owensboro, Paducah, Somerset/London 
• o Willing to travel to perform face to face with members and attend meeting (50%-75%)
• o 1-2 years experience in call center or customer service environment

o 1-2 years experience in healthcare field (i.e. experienced in medical office, hospital setting, and familiarity with medical terminology  

o Effective communication, telephonic and organizational skills with the ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm

o Demonstrate ability to meet daily metrics with speed, accuracy, and positive attitude and strong written and oral communication skills

o Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members, adhering to care management processes to include but not limited to privacy and confidentiality, quality management processes in compliance with regulatory accreditation guidelines, and company policies and procedures.

o Basic awareness of problem solving and decision making skills  

Education
High School Diploma and 2+ years of college (Associates degree)

Preferred Qualifications

Bachelor's Degree, 2-4 years Case management and discharge planning experience preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$21.10 - $36.78

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

We anticipate the application window for this opening will close on: 10/08/2025

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