Case Management Specialist

Job Description:

  • Engage telephonically with members for 50–75% of the day and coordinate their care
  • Conduct annual Health Risk Assessment Surveys
  • Utilize available resources to reach and engage hard-to-reach members
  • Partner with members to develop individualized care plans with goals and interventions
  • Document care management activities in members’ electronic health records
  • Collaborate with the Interdisciplinary Care Team to address barriers to care and maintain stable health conditions
  • Identify and connect members with health plan benefits and community resources
  • Meet regulatory requirements within specified timelines
  • Consult with the Care Manager RN regarding clinical knowledge, medication regimens, and supportive clinical decision-making
  • Support team objectives and operational efficiency
  • Participate in special projects and process improvement initiatives
  • Assist with mentoring new team members

Requirements:

  • 2+ years of experience in a health-related field
  • 2+ years of customer service experience
  • Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams)
  • Ability to effectively utilize Microsoft Office tools within the Case Management Specialist role
  • Access to a private, dedicated space to conduct work effectively and meet position requirements
  • Experience or willingness to thoroughly learn care management within Medicare and Medicaid managed care
  • Familiarity with community resources and services
  • Ability to navigate and utilize healthcare technology tools
  • Effective verbal and written communication
  • Excellent customer service and engagement skills
  • Associate’s Degree AND relevant experience in a health care-related field OR Practical Nurse Degree/Certificate with active licensure that meets state requirements (REQUIRED)
  • Experience providing care management for Medicare and/or Medicaid members (preferred)
  • Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health (preferred)
  • Experience conducting health-related assessments and facilitating care planning processes (preferred)
  • Bilingual skills, especially English-Spanish (preferred)

Benefits:

  • CVS Health bonus, commission or short-term incentive program in addition to base pay
  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Other resources supporting physical, emotional, and financial well-being, based on eligibility
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