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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
