Care Manager Specialist

CVS Health; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

CVS Health is seeking a telephonic Care Manager Specialist to join their Special Needs Plan care team. The role involves coordinating care for members, particularly those with health needs and social determinants of health, through dedicated outreach and collaboration. Ideal candidates will have previous health-related experience, strong communication skills, and a commitment to enhancing member care. Join a leading health solutions company and contribute to the well-being of millions across the nation while enjoying competitive pay and benefits.

Benefits

Affordable medical plan options

401(k) plan with company matching

Employee stock purchase plan

No-cost wellness programs

Flexible work schedules

Tuition assistance

Qualifications

• 2+ years of experience in a health-related field.
• 2+ years of customer service experience.
• Access to a private, dedicated space to work.

Responsibilities

• Engaging with members and coordinating their care (50-75% of the day).
• Developing individualized care plans.
• Maintaining documentation in the electronic health record.

Skills

Communication Skills

Customer Service

Collaboration

Care Management Knowledge

Technical Proficiency

Community Resources

Professional Conduct

Education

Associate’s Degree in a health care-related field

Tools

Microsoft Office Suite

Job description

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 member’s needs through the completion of the annual Health Risk 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.
• Additional Responsibilities: Support team objectives, enhance operational efficiency, and ensure the 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.
• Technical Proficiency: Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and ability to effectively utilize these tools within the CMS role.
• 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.
• Work Environment: Access to a private, dedicated space to conduct work effectively to meet the requirements of the position.

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 member’s needs through the completion of the annual Health Risk 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.
• Additional Responsibilities: Support team objectives, enhance operational efficiency, and ensure the 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.
• Technical Proficiency: Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and ability to effectively utilize these tools within the CMS role.
• 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.
• Work Environment: Access to a private, dedicated space to conduct work effectively to meet the requirements of the position.

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: 07/07/2025

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

About the company

At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit.

Notice

Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at [e-mail] or 407-000-0000.

Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.

An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report . NYC applicants may request an alternative process or accommodation at [e-mail] or 407-000-0000.