Case Management Coordinator – Medicare/Medicaid, Winnebago

Hispanic Alliance for Career Enhancement; 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

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.