Case Management Coordinator

About CVS Health

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. 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 – caring 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.

Employment Type: Full time Anticipated Weekly Hours: 40 Time Type: Full time

Job Description

Utilizes skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for members by providing care coordination, support and education for members through the use of care management tools and resources.

Evaluation of Members

• Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred 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 referrals.
• Coordinates and implements assigned care plan activities and monitors care plan progress.

Enhancement of Medical Appropriateness and Quality of Care

• Uses a holistic approach to overcome barriers to meet 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.
• Helps member actively and knowledgeably participate with their provider in healthcare decision-making.

Monitoring, Evaluation, and Documentation of Care

• Utilizes case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

• 2+ years of case management experience working with people who have been designated as having a serious mental illness (SMI) and working with people who are elderly or have a physical disability.
• Computer proficient with Microsoft Outlook/Word and Windows

Preferred Qualifications

• Experience collaborating with medical professionals
• Critical areas to succeed - organization, collaboration and time management

Education

Candidates must have earned a 4-year bachelor’s degree in Human Services and Related Fields.

Approved Degrees:

• Art Therapy
• Behavioral Sciences
• Child Development
• Child and Family Studies/Services
• Cognitive Sciences
• Community Mental Health
• Counseling (MH, Vocational, Pastoral, etc.)
• Counselor Education
• Early Childhood Development
• Education (with a focus in psychology and/or special education)
• Educational Psychology
• Family Development/Relations
• Health and Human Services
• Human Development
• Human Services
• Marriage and Family Therapy
• Nursing
• Pharmacy
• Psychiatric Rehabilitation
• Psychology
• Rehabilitation Counseling
• Social Work
• Sociology
• Special Education
• Speech Therapy
• Therapeutic Recreation
• Vocational Rehabilitation

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