Case Management Specialist

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.

As an essential member of our Special Needs Plan (SNP) care team, the telephonic Care Manager Specialist (CMS) plays a key role in coordinating the care of our members, particularly those with social determinants of health (SDoH) needs and stable health conditions. The CMS collaborates closely with the Registered Nurse Care Manager, Care Coordinator, Social Worker, and other interdisciplinary care team participants to support the member in maintaining optimal health.

This is achieved by evaluating the members' needs through the completion of the annual Health Risk Assessment Survey, addressing SDoH needs, and closing gaps in preventative and health maintenance care.

• Telephonic Engagement: Dedicate 50-75% of the day to engaging with members and coordinating their care.
• Member Outreach: Utilize all available resources to connect with and engage "hard-to-reach" members.
• Care Planning: Partner with members to develop individualized care plans that encompass goals and interventions to meet their identified needs.
• Documentation: Maintain meticulous documentation of care management activities in the member's electronic health record.
• Collaboration: Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member's stable health condition.
• Resource Connection: Identify and connect members with health plan benefits and community resources.
• Regulatory Compliance: Meet regulatory requirements within specified timelines.
• Consults with the Care Manager RN within the Care Team for clinical knowledge, medication regimes, and supportive clinical decision making
• Collaborates and leverages 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. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.

• 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.

• 2+ years of experience in a health-related field
• 2+ years of customer service experience
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, One Note, 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.

• 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