Care Manager Specialist

CVS Health Corporation; Mississippi; Remote; USD 10,000 - 60,000; Full time

Job summary

CVS Health is seeking a Care Manager Specialist to coordinate care for members, particularly focusing on those with social determinants of health needs. The role requires collaboration with a care team, engagement through telephonic outreach, and robust documentation. Ideal candidates have a background in health care and excellent customer service skills, making an impact in a supportive environment.

Benefits

Affordable medical plan options

401(k) plan including matching contributions

Employee stock purchase plan

Paid time off and flexible work schedules

Tuition assistance

Qualifications

• 2+ years of experience in a health-related field.
• Proficient in Microsoft Office Suite.
• Experience working with social determinants of health.

Responsibilities

• Engage with members and coordinate their care 50-75% of the day.
• Develop individualized care plans with members.
• Document care management activities in the electronic health record.

Skills

Care Management Knowledge

Communication Skills

Customer Service

Collaboration

Healthcare Technology

Education

Associate’s Degree in a health care-related field

Tools

Microsoft Office Suite

Job description

time left to apply End Date: June 4, 2025 (4 days left to apply)

job requisition id R0602743

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Purpose and Summary

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.

Key Responsibilities

• 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.

Essential Competencies and Functions

• 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.

Required Qualifications

• 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 within the CMS role
• Access to a private, dedicated space to conduct work effectively to meet the requirements of the position

Preferred Qualifications

• 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

Education:

• Associate’s Degree and relevant experience in a health care-related field (REQUIRED)
• Practical Nurse Degree/Certificate with active licensure that meets state requirements OR Bachelor’s Degree in health care or a related field (PREFERRED)

Anticipated Weekly Hours

40

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Purpose and Summary

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.

Key Responsibilities

• 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.

Essential Competencies and Functions

• 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.

Required Qualifications

• 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 within the CMS role
• Access to a private, dedicated space to conduct work effectively to meet the requirements of the position

Preferred Qualifications

• 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

Education:

• Associate’s Degree and relevant experience in a health care-related field (REQUIRED)
• Practical Nurse Degree/Certificate with active licensure that meets state requirements OR Bachelor’s Degree in health care or a related field (PREFERRED)

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$21.10 - $36.78

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 06/04/2025

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

About us

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.