Case Management Specialist
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Job Description
Care Management Specialist coordinating telephonic care, assessments, and resources for CVS Health Medicare and Medicaid members. Supporting interdisciplinary teams and closing health and social-needs care gaps.
Responsibilities:
- Engage telephonically with members for 50–75% of the day and coordinate their care
- Conduct member outreach using available resources to engage hard-to-reach members
- Complete annual Health Risk Assessment Surveys
- Address social determinants of health needs and close preventive and health maintenance care gaps
- 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 stable health conditions
- 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 regimes, 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 Care Manager Specialist role
- Access to a private, dedicated space to conduct work effectively
- Dependents must have separate care arrangements during work hours
- Associate’s Degree AND relevant experience in a health care-related field (REQUIRED)
- 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
- Ability to meet performance and productivity metrics
- Effective verbal and written communication
- Excellent customer service and engagement skills
- Preferred: 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
- Practical Nurse Degree/Certificate with active licensure meeting state requirements OR Bachelor’s Degree in health care or a related field (PREFERRED)
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to the base pay range
- 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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