Field Case Management Analyst

Coordinates care for Medicaid members in West Virginia by assessing needs and eligibility, developing and monitoring care plans, and connecting members with appropriate healthcare and community services. The role includes field visits across the Northern region and collaboration with case managers, providers, and other health programs.

Responsibilities

• Evaluate members' needs and eligibility using case management tools, data, benefit plans, and available services.
• Identify high-risk factors and service needs, and refer members to clinical case management or crisis intervention when appropriate.
• Coordinate assigned care plan activities and monitor progress toward care goals.
• Collaborate with case managers, supervisors, Medical Directors, and health programs to address barriers to care.
• Identify and escalate quality-of-care concerns through established channels.
• Coach and educate members to support engagement, healthy choices, and participation in healthcare decisions.

Required Skills

• Case management tools
• Member needs assessment
• Eligibility assessment
• Care plan coordination
• Care coordination
• Healthcare benefits analysis
• Risk identification
• Quality management processes
• Motivational interviewing
• Healthcare documentation