Case Management Coordinator

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🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $21 - $44 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. • Facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources. • Conducts comprehensive evaluation of member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. • Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. • Coordinates and implements assigned care plan activities and monitors care plan progress. • Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes. • Identifies and escalates quality of care issues through established channels. • Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs. • Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. • Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. • Engages with colleagues in ongoing team meetings and offers peer mentoring/training. • Helps member actively and knowledgably participate with their provider in healthcare decision-making. • Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

🎯 Requirements

• Case management and discharge planning experience preferred • 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus • Managed Care experience preferred • Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually • Ability to travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise • Excellent analytical and problem-solving skills • Effective communications, organizational, and interpersonal skills • Ability to work independently • Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications. • Efficient and Effective computer skills including navigating multiple systems and keyboarding

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources