CVS Health is seeking an Analyst, Case Management Field to support care coordination for members in the community. In this role, you will analyze clinical and claims data, identify high risk patients, and partner with nurses, social workers, and providers to close care gaps. You'll schedule outreach, document cases, track outcomes, and escalate complex issues. You will use care management and CRM tools, generate reports, and recommend process improvements while supporting CVS Health's mission to deliver accessible, high quality, and affordable care.
Responsibilities
- Analyze clinical and claims data to identify high-risk or high-cost members
- Support field case managers with scheduling, outreach, and follow-up tasks
- Document member interactions and care plans in care management systems
- Track case status, outcomes, and quality metrics; prepare regular reports
- Collaborate with nurses, social workers, and providers to close care gaps
- Escalate complex clinical or social needs to licensed professionals
- Maintain compliance with HIPAA and internal quality standards
- Use Excel, reporting tools, and CRM platforms to manage caseloads
- Recommend process improvements to enhance efficiency and member experience
- Support CVS Health initiatives that improve access to affordable care
Required Skills
- Case management support
- Healthcare data analysis
- Care coordination
- EMR/EHR systems
- Claims and utilization review
- Reporting and dashboards
- Microsoft Excel
- CRM or care management platforms
- Regulatory and compliance awareness
- Communication and documentation
