Case Management Coordinator – Transition of Care Team

Job Description:

  • Evaluate referred members' needs and eligibility using care management tools and data review
  • Recommend case-resolution approaches and evaluate benefit plans and internal/external programs and services
  • Identify high-risk factors and service needs affecting member outcomes and care planning
  • Refer members to clinical case management or crisis intervention when appropriate
  • Coordinate, implement, and monitor assigned care plan activities
  • Consult with case managers, supervisors, Medical Directors, and other health programs to overcome barriers
  • Present cases at multidisciplinary case conferences
  • Identify and escalate quality-of-care issues through established channels
  • Negotiate appropriate options and services for members' benefits and healthcare needs
  • Use motivational interviewing to engage members and promote lifestyle or behavior changes
  • Provide coaching, information, and support for independent medical and healthy lifestyle choices
  • Help members participate knowledgeably in healthcare decisions with providers
  • Monitor, evaluate, and document care in compliance with regulatory, accreditation, and company requirements

Requirements:

  • 2+ years of experience in behavioral health or social services
  • Ability to work 8:00 AM–5:00 PM in the assigned market time zone
  • 2+ years of experience with Microsoft Office Applications (Word, Excel, Outlook)
  • Dedicated workspace free of interruptions
  • Separate care arrangements for dependents during work hours
  • Case management and discharge planning experience preferred
  • Managed care experience preferred
  • Bachelor's Degree or non-licensed master level clinician degree in behavioral health or human services preferred, or equivalent experience (REQUIRED)
  • Direct/hardwired internet connection to a modem/router within 7 feet of the computer
  • Minimum internet speed of 25 Mbps download and 3 Mbps upload
  • WiFi and satellite internet are not permitted
  • Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines
  • Ability to work within the state and city where the candidate currently lives
  • Microsoft Office 365 applications or similar Google Workspace experience
  • Ability to navigate multiple monitors and applications
  • Ability to use email, calendar invites, Teams messaging, and virtual meetings
  • Ability to log in to secure systems such as VPN and EHR portals
  • Ability to maintain strong passwords and recognize suspicious emails or links
  • Ability to troubleshoot common technical issues independently

Benefits:

  • CVS Health bonus, commission or short-term incentive program in addition to base pay
  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs
  • Other resources supporting physical, emotional, and financial well-being
  • Company-provided equipment, including keyboard, monitor, computer, and headset
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