Case Management Analyst

CVS Health • Richmond, Virginia, United States • 7h ago

CVS Health is seeking a Case Management Analyst to support data-driven, patient-centered care across its healthcare network. In this role, you will analyze member cases, clinical records, and claims data to support utilization management, identify care gaps, and improve outcomes and affordability. You'll collaborate with nurses, providers, and care teams, prepare clear documentation and reports, and help optimize workflows while maintaining strict HIPAA compliance. CVS Health offers competitive benefits, inclusive culture, and growth opportunities through training and internal mobility.

Responsibilities

Analyze member cases to support utilization management and care coordination
Review clinical and claims data to identify gaps in care and optimize outcomes
Prepare case summaries, documentation, and reporting for clinical teams and leadership
Collaborate with nurses, physicians, social workers, and pharmacy teams on care plans
Support prior authorization, appeals, and benefits clarification processes
Use case management and analytic tools to track caseloads and performance metrics
Ensure compliance with clinical guidelines, HIPAA, and CVS Health policies
Communicate with members and providers to gather information and resolve issues
Identify high-risk or high-cost cases for targeted interventions
Contribute to continuous improvement of case management workflows and standards

Required Skills