Job Description: Care Coordinator

Employment Type: Full-time

Position Overview

At CVS Health, we are building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming healthcare. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues. We care for people where, when, and how they choose, in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day.

Join our Aetna care management team as we lead the way in providing exceptional care to dual eligible populations! You will have a life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in both Medicare and Medicaid. As a member of the care team, you will collaborate with members, the internal care team, healthcare providers, and community organizations to meet the complex healthcare and social needs of our members. Be part of this exciting opportunity as we expand our DSNP services to transform lives in new markets across the country.

As a vital member of our Special Needs Plan (SNP) care team, the Care Coordinator (CC) is responsible for coordinating care for our members through close collaboration with the Care Manager, Social Worker, and other interdisciplinary team members. This role involves evaluating member needs through the annual Health Risk Survey, addressing social determinants of health (SDoH), coordinating care across the continuum, and closing gaps in preventive and health maintenance care.

Key Responsibilities

• Member Evaluation: Conduct the annual Health Risk Survey to support needs identification for the member’s Individual Plan of Care.
• Risk Escalation: Inform the assigned care manager of newly identified health/safety risks or service needs.
• Care Coordination: Complete care coordination activities delegated by the care manager within an established timeframe.
• Quality Issue Escalation: Inform the assigned care manager and/or associate manager of any identified quality of care issues.
• Advocacy: Passionately support the member’s care coordination needs and drive solutions to address those needs.
• Member Engagement:
  • Use problem-solving skills to find alternative contact information for members who are unreachable by care management.
  • Employ motivational interviewing techniques to maximize member engagement and promote lifestyle changes for optimal health.
• Monitoring and Documentation: Adhere to case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies.

Essential Competencies and Functions

• Meet performance and productivity metrics, including call volume, successful member engagement, and compliance with state/federal regulatory requirements.
• Conduct oneself with integrity, professionalism, and self-direction.
• Demonstrate a willingness to learn about care management within Medicare and Medicaid managed care.
• Familiarity with community resources and services.
• Navigate various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
• Maintain strong collaborative and professional relationships with members and colleagues.
• Communicate effectively, both verbally and in writing.
• Exhibit excellent customer service and engagement skills.

Required Qualifications

• 2+ years in behavioral health, social services, or a related field relevant to the program focus.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and capable of utilizing these tools effectively in the CM Coordinator role.
• Access to a private, dedicated workspace to fulfill job requirements effectively.
• Education: High School Diploma with equivalent experience (REQUIRED).

Preferred Qualifications

• Case management and discharge planning experience.
• Managed care experience.
• Education: Associate’s or Bachelor’s Degree or non-licensed master’s level.