Case Management Coordinator NE Region OH at CVS Health

Cincinnati, Ohio, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Medicaid Managed CareIndustries

Requirements

Must reside in Ohio, preferably in Summit or Stark counties within Northeast Ohio
Ability to travel within Northeast Ohio to member homes and locations up to 50% or more of the time
Clinically and culturally competent/responsive with training and experience to manage complex cases in the community across child-serving systems
Availability for full-time field-based telework, Monday-Friday 8-5pm with flexibility to work later as needed

Responsibilities

Conduct comprehensive evaluation of referred member's needs/eligibility using care management tools and data review, recommend case resolution approaches, identify high-risk factors, and refer to clinical case management or crisis intervention as appropriate
Coordinate and implement assigned care plan activities and monitor care plan progress
Consult with case managers, supervisors, Medical Directors, and other programs using a holistic approach to overcome barriers, present cases at conferences for multidisciplinary review, and achieve optimal outcomes
Work collaboratively with members' Child and Family Teams
Identify and escalate quality of care issues through established channels
Utilize negotiation skills to secure appropriate options and services meeting member's benefits and healthcare needs
Use influencing/motivational interviewing skills to ensure member engagement, promote lifestyle/behavior changes, provide coaching, information, and support for independent medical/healthy lifestyle choices
Help members actively participate with providers in healthcare decision-making and serve as a single point of contact to remediate immediate and acute gaps in care and access
Monitor, evaluate, and document care using case management and quality tools

Skills

Case Management

Care Coordination

Critical Thinking

Behavioral Health

Medicaid

OhioRISE

Cultural Competence

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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