Job Description:
• Conduct comprehensive evaluations of referred members’ needs and eligibility using care management tools and data review
• Evaluate benefit plans and internal and external programs/services to recommend case resolution approaches
• 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 engage members and promote lifestyle/behavior changes
• Provide coaching, information, and support to empower members’ 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 guidelines
• Travel to member homes, residential treatment facilities, group homes, shelters, and detention facilities in Northern West Virginia
Requirements:
• 2 years’ experience in behavioral health, social services, or an appropriate related field equivalent to program focus
• West Virginia residency in one of the following counties: Barbour, Brooke, Doddridge, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Ritchie, Taylor, Tyler, Upshur, or Wetzel
• Reliable transportation and willingness and ability to travel in the assigned region 50% or more of the time
• 2+ years of experience with personal computer, 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
• Direct/hardwired internet connection to a modem/router within 7 feet of the computer, with minimum 25 Mbps download and 3 Mbps upload speeds
• WiFi and satellite internet are not permitted
• Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines
• Must work within the state and city where currently living
• Must provide own workspace furniture
• Ability to use multiple monitors and navigate multiple applications simultaneously
• Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
• Experience with Microsoft Office 365 or similar Google Workspace applications
• Ability to log in to secure systems such as VPN and EHR portals, secure devices, manage strong passwords, and recognize suspicious emails or links
• Ability to troubleshoot common technical issues independently
• Openness to learning new skills as the workplace evolves
Benefits:
• Mileage is reimbursed per company expense reimbursement policy
• Company-provided equipment (keyboard, monitor, computer, headset, etc.)
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being
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