Case Management Coordinator, Field (Winnebago County, IL)

CVS Health; Springfield (IL); Hybrid; USD 28,929 - 61,992; Full time

Job summary

CVS Health in Illinois is seeking a Case Management Coordinator to support Aetna members, including dual eligible populations. You will collaborate with providers, community organizations, and care teams to facilitate scheduling, benefits access, and member education.

This role emphasizes independent work and remote collaboration. The position requires a Bachelor’s or non-licensed Master’s in behavioral health or human services, with travel up to 75% around Winnebago County.

Qualifications

• 2 years experience in behavioral health, social services or related field.
• Willingness to travel up to 75% in and around Winnebago County; mileage reimbursed per policy.
• Must be able to work remotely/home-based and collaborate virtually.
• Excellent analytical and problem-solving skills.
• Effective communications, organizational and interpersonal skills.
• Proficiency with standard corporate software applications (MS Word, Excel, Outlook, PowerPoint).
• Ability to work independently.

Responsibilities

• Evaluate members' needs/eligibility and tailor care plans.
• Coordinate and monitor care plan progress and outcomes.
• Identify high-risk factors and refer to clinical case management or crisis intervention when needed.
• Collaborate with case managers, supervisors, Medical Directors and other health programs.
• Identify and escalate quality of care issues through established channels.
• Use negotiation and motivational interviewing to secure services for members.
• Coach and support members to engage with providers and make healthy choices.
• Participate in team meetings and provide peer mentoring/training.
• Help members participate actively in healthcare decisions.

Skills

Analytical skills

Communication skills

Independent work

Education

Bachelor's degree in behavioral health or human services

Master's degree in behavioral health or human services (non-licensed)

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 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 Case Management 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: Through the use of care management tools and information/data review, conducts comprehensive evaluation of member’s needs/eligibility and recommends 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: Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents 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 healthcare 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 knowledgably participate with their provider in healthcare decision-making.
• Monitoring, Evaluation and Documentation of Care: Utilizes 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 our company expense reimbursement policy
• Excellent analytical and problem‑solving skills
• Effective communications, 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 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 (https://learn.bswift.com/cvshealth-mainland).

Equal Opportunity Statement

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

CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran — committed to diversity in the workplace.