Case Management Specialist

Job Purpose And Summary

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Key Responsibilities

• Dedicate 50-75% of the day to engaging with members and coordinating their care.
• Utilize all available resources to connect with and engage “hard-to-reach” members.
• Partner with members to develop individualized care plans that encompass goals and interventions to meet their identified needs.
• Maintain meticulous documentation of care management activities in the member’s electronic health record.
• Collaborate with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
• Identify and connect members with health plan benefits and community resources.
• Consult with the Care Manager RN within the Care Team for clinical knowledge, medication regimes, and supportive clinical decision making.
• Collaborate and leverage the Care Manager RN clinical expertise to ensure members’ needs are adequately addressed.

Additional Responsibilities

• Support team objectives, enhance operational efficiency, and ensure delivery of high-quality care to members.

Essential Competencies And Functions

• Performance Metrics: Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements.
• Professional Conduct: Conduct oneself with integrity, professionalism, and self-direction.
• Care Management Knowledge: Experience or willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care.
• Community Resources: Familiarity with community resources and services.
• Healthcare Technology: Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
• Collaboration: Maintain strong collaborative and professional relationships with members and colleagues.
• Communication Skills: Communicate effectively, both verbally and in writing.
• Customer Service: Excellent customer service and engagement skills.

Required Qualifications

• 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) and ability to effectively utilize these tools within the Case Management Specialist (CMS) role.
• Access to a private, dedicated space to conduct work effectively to meet the requirements of the position.

Preferred Qualifications

• Experience providing care management for Medicare and/or Medicaid members.
• Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health.
• Experience conducting health-related assessments and facilitating the care planning processes.
• Bilingual skills, especially English-Spanish.

Education

• 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).
• Bachelor’s Degree in health care or a related field (PREFERRED).

Pay Range

The Typical Pay Range For This Role Is $21.10 - $40.90 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Anticipated Weekly Hours

40

Time Type

Full time