Case Management Specialist

Job Description:

  • Engage telephonically with members for 50–75% of the workday
  • Coordinate care for Special Needs Plan members, particularly those with social determinants of health needs and stable health conditions
  • Complete annual Health Risk Assessment Surveys
  • Address social determinants of health needs and close preventive and health maintenance care gaps
  • Conduct outreach to hard-to-reach members using available resources
  • Develop individualized care plans with members, including 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 members’ stable health
  • Connect members with health plan benefits and community resources
  • Meet regulatory requirements within specified timelines
  • Consult with and leverage the Care Manager RN’s clinical expertise for 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
  • Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams
  • Ability to effectively use Microsoft Office tools within the Case Management Specialist role
  • Associate’s degree and relevant experience in a health care-related field (required)
  • Access to a private, dedicated workspace
  • Direct/hardwired internet connection to a modem/router within 7 feet of the computer
  • Minimum internet speed of 25 Mbps download and 3 Mbps upload
  • WiFi and satellite internet are not permitted
  • Quiet, secure, private home work location compliant with CVS Health and HIPAA guidelines
  • Must work within the state and city where currently living
  • Practical Nurse Degree/Certificate with active licensure meeting state requirements or bachelor’s degree in health care or related field (preferred)
  • Experience or willingness to learn care management within Medicare and Medicaid managed care
  • Familiarity with community resources and services
  • Ability to navigate healthcare technology tools
  • Ability to meet performance, productivity, call volume, member engagement, and regulatory metrics
  • Effective verbal and written communication skills
  • Excellent customer service and engagement skills
  • Experience providing care management for Medicare and/or Medicaid members (preferred)
  • Experience with individuals with SDoH needs, chronic medical conditions, and/or behavioral health (preferred)
  • Experience conducting health-related assessments and facilitating care planning (preferred)
  • Bilingual skills, especially English-Spanish (preferred)
  • Ability to use multiple monitors and applications simultaneously
  • Experience with Microsoft Office 365 applications or similar tools such as Google Workspace
  • Ability to use secure systems such as VPN and EHR portals
  • Ability to 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:

  • 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
  • Company-provided equipment, including keyboard, monitor, computer, and headset
  • Remote work from a designated home workspace
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