Analys, Case Management, Field

4004 Aetna Medicaid Administrators; EE. UU.; A distancia; USD 29.000 - 56.000; Jornada completa

Descripción de la vacante

CVS Health is hiring a Care Management Coordinator to support care coordination across the continuum. You will assess, plan, implement, coordinate, monitor and evaluate member care, using tools and resources to drive positive health outcomes.

The role emphasizes engaging with members, coordinating with providers, and guiding them through plans of care. Strong communication, organizational skills and regulatory compliance are essential.

Formación

• 2 years of related professional experience in care management or related health services.
• Strong customer service orientation and problem solving.
• Excellent motivational interviewing skills and ability to build rapport remotely.
• Excellent documentation and compliance with regulatory standards.
• Highly organized with time management and ability to travel.

Responsabilidades

• Uses care management tools to evaluate members and determine appropriate care plans.
• Identify high-risk factors and coordinate referrals to clinical care management or crisis intervention as needed.
• Employ motivational interviewing to maximize member engagement and promote healthy choices.
• Educate and empower members to participate in decisions with providers.
• Coordinate and monitor care plan activities and progress with the interdisciplinary team.
• Escalate quality of care issues through established channels and ensure HIPAA compliance.

Conocimientos

Care coordination

Motivational interviewing

Customer service

Documentation

Time management

Travel ability

Educación

Bachelor’s degree in social work, psychology, or a related health or social services field

Herramientas

Microsoft Office 365

Descripción del empleo

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.

Summary:

Care Management Coordinators (CMC) drive and support care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). The CMC utilizes critical thinking and judgment to collaborate and inform the care management/care coordination process in order to facilitate appropriate healthcare outcomes for assigned members. They provide care coordination, support and education for members through the use of care management tools and resources.

Position Responsibilities:

Uses care management tools and information to complete a comprehensive evaluation of members and recommends an approach to case resolution by determining member needs in alignment with their benefit plan and available internal and external programs and services. Identifies high risk factors and service needs that may impact member outcomes and care planning with appropriate referral to clinical case management or crisis intervention as appropriate. Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve an 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 knowledgably participate with their provider in healthcare decision-making. Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access. Coordinates and implements assigned care plan activities and monitors care plan progress. Using a holistic approach consults with clinical care managers, leadership, medical directors and other physical/behavioral health support staff and providers to overcome barriers to meeting member goals and objectives. Presents cases at case conferences/rounds to obtain multidisciplinary review in order to achieve optimal outcomes. Works collaboratively with the members’ interdisciplinary care team. In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals. Identifies and escalates quality of care issues through established channels. Monitors, evaluates and documents care utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Identifies, refers, and links members to providers and social supports as needed (e.g., scheduling appointments, arranging transportation). Educates members about available resources and services such as Texas value-added benefits and assisting the member in accessing those resources and services. Facilitates clinical hand-offs during transitions of care.

Reports to:

Manager, Clinical Health Services, Care Management

Educational and Experience Requirements:

2 years of related professional experience includes acting as a care manager, rehabilitation specialist, health specialist, social services coordinator, or licensed behavioral health professional in the State of Texas Strong Customer Service Orientation and Problems Solving Excellent Motivational Interviewing Skills/ability to build rapport and trust telephonically Excellent in documentation and respecting compliance/regulatory standards Highly organized, remain self-driven without direct supervision Manage time effectively Achieve Performance Metrics Technology Proficiency Variable work schedules with the ability to work 2 days weekly until 9pm local time. Ability to travel surrounding counties

Preferred Qualifications

Experience in case management and discharge planning. Experience working with maternity and NICU populations. Managed care experience.

Work from Home Requirements

You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted. A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours. Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live. The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time). If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements

Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency. Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings. Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace). Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links. Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.

Future Growth

Openness to learning new skills in the future as the workplace environment evolves

License/Credential Requirements:

• Bachelor’s degree in social work, psychology, or a related health or social services field

Anticipated Weekly Hours

40

Time Type

Full time

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 salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.