Case Management Coordinator - Field - Southern IL

4004 Aetna Medicaid Administrators; Illinois; On-site; USD 24,000 - 50,000; Full time

Benefits offered by this job

Comprehensive benefits

Job summary

CVS Health is hiring a Case Management Coordinator in southern Illinois to telephonically and face-to-face assess, plan, implement, and coordinate case management activities. You will evaluate medical needs and support members’ overall wellness, addressing barriers and risks with a holistic approach.

The role requires 2+ years in case management or related fields, willingness to travel up to 75%, and a valid IL driver's license.

Qualifications

• Minimum of 2 years of experience in case management, behavioral health, social services, or related field.
• Willing and able to travel 50-75% of time to meet members face to face.
• Valid Driver's License, preferably in IL.

Responsibilities

• Assess, plan, implement and coordinate case management activities with members to evaluate medical needs and support overall wellness.
• Review prior claims to assess potential impact on case management and eligibility.
• Utilize clinical judgment to reduce risk factors and barriers and address complex health and social indicators.
• Consult with supervisors and participate in case conferences to improve care planning and outcomes.

Skills

Travel willingness

Valid driver’s license

Case management experience

Behavioral health experience

Education

Bachelor's degree

Master-level clinician

Tools

Microsoft Office

Job description

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.

Position Summary Case Management Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.

• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.
• Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
• Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Assessments include the member's level of work capacity and related restrictions/limitations.
• Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required Qualifications

Candidate must reside in southern Illinois and surrounding counties Minimum of 2 years of experience in case management, behavioral health, social services, or related field Willing and able to travel using your own vehicle 50-75% of their time to meet with members face to face in surrounding areas Valid Drivers License, preferably in IL

Preferred Qualifications

Long Term Care Experience Case Management or Discharge Planning experience Managed care experience Microsoft Office (Excel) experience Education: Bachelor's Degree or non-licensed master level clinician required, preferably with a degree either being in behavioral health or human services

Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $21.10 - $44.99 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 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. We anticipate the application window for this opening will close on: 11/16/2026

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

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.