Case Management Coordinator, Field (Winnebago County, IL)

CVS Health; Rockford (IL); Hybrid; USD 44,000 - 94,000; Full time

Job summary

CVS Health is seeking a Case Management Coordinator in Illinois to support members enrolled in Medicare and Medicaid, collaborating with care teams to improve outcomes. You will schedule appointments, help access benefits, and educate members using care management tools while navigating complex health and social needs.

In this role, you’ll analyze member needs, identify high-risk factors, coordinate care plan activities, and advocate for options to meet benefits and health-care goals.

Qualifications

• Bachelor's degree or non-licensed master level clinician in behavioral health or human services (psychology, social work, marriage and family therapy, counseling).
• 2 years experience in behavioral health or appropriate related field equivalent to program focus.
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually.
• Must possess reliable transportation and be willing and able to travel up to 75% of the time in and around Winnebago County; mileage is reimbursed per company expense reimbursement policy.
• Excellent analytical and problem-solving skills.
• Effective communication, organizational, and interpersonal skills.
• Ability to work independently.
• Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
• Efficient and effective computer skills including navigating multiple systems and keyboarding.

Responsibilities

• Evaluation of Members: use care management tools and data to evaluate needs/eligibility and plan approach.
• Identify high risk factors and service needs impacting outcomes and refer to clinical case management.
• Coordinate and implement assigned care plan activities and monitor progress.
• Collaborate with medical directors and health programs to overcome barriers to goals.
• Identify and escalate quality of care issues through established channels.
• Use negotiation skills to secure options and services to meet needs.
• Engage members with coaching and motivational interviewing to aid healthy choices.
• Provide ongoing support to empower independent medical decisions.
• Participate in team meetings and mentor/train peers.
• Help members participate with providers in decision-making.
• Document care in line with regulatory and company policies.

Skills

Behavioral health experience

Travel up to 75%

Communication skills

MS Office proficiency

Education

Bachelor's degree or non-licensed master level clinician in behavioral health or human services

Tools

MS Word

Excel

Outlook

PowerPoint

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.

Program Overview

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in‑class operating and clinical models. You can have a life‑changing impact on our members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

Position Summary / Mission

The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources.

Fundamental Components

• Evaluation of Members: Use care management tools and information/data review to conduct a comprehensive evaluation of member needs/eligibility and recommend an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
• Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Enhancement of Medical Appropriateness and Quality of Care: Use a holistic approach to consult with case managers, supervisors, medical directors and/or other health programs to overcome barriers to meeting goals and objectives; present cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or health‑care needs.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Engages with colleagues in ongoing team meetings and offers peer mentoring/training.
• Helps member actively and knowingly participate with their provider in health‑care decision‑making.
• Monitoring, Evaluation and Documentation of Care: Uses case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

• Must live in or near Winnebago County, IL.
• 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus.
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually.
• Must possess reliable transportation and be willing and able to travel up to 75% of the time in and around Winnebago County; mileage is reimbursed per company expense reimbursement policy.
• Excellent analytical and problem‑solving skills.
• Effective communication, organizational, and interpersonal skills.
• Ability to work independently.
• Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
• Efficient and effective computer skills including navigating multiple systems and keyboarding.

Preferred

• Case management and discharge planning experience.
• Managed Care experience preferred.

Education

• Bachelor's degree or non‑licensed master level clinician required with either degree being in behavioral health or human services (psychology, social work, marriage and family therapy, counseling).

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is $21.10 - $44.99. This 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, geographic location 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. Benefits include medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources based on eligibility.

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