[Remote] Case Management Specialist (EST) at CVS Health

Maine, Wisconsin, United States

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

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
Access to a private, dedicated space to conduct work effectively

Responsibilities

Dedicate 50-75% of the day to telephonic engagement 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
Work 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
Meet regulatory requirements within specified timelines
Consult with the Care Manager RN 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
Support team objectives, enhance operational efficiency, and ensure delivery of high-quality care (e.g., participate in special projects, process improvement, mentoring new team members)
Meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements

Skills

Key technologies and capabilities for this role

Care ManagementTelephonic EngagementHealth Risk AssessmentCare PlanningDocumentationInterdisciplinary CollaborationSDoHMember OutreachElectronic Health Record

Questions & Answers

Common questions about this position

Is this a remote position or does it require office work?

This information is not specified in the job description.

What are the key skills required for the Case Management Specialist role?

Key skills include telephonic engagement with members, care planning, meticulous documentation, collaboration with interdisciplinary teams, and meeting performance metrics like call volume and regulatory requirements.

What does the team structure look like for this role?

The role is part of an interdisciplinary care team including the Registered Nurse Care Manager, Care Coordinator, Social Worker, and other participants, with close collaboration and consultation with the Care Manager RN.

What is the compensation or salary for this position?

This information is not specified in the job description.

What makes a strong candidate for this Case Management Specialist position?

Strong candidates demonstrate care management knowledge, professional conduct with integrity and self-direction, ability to meet performance metrics, and experience or willingness to learn the role, including supporting team objectives and process improvements.

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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