Remote Case Management Coordinator – Health & Benefits

CVS Health; Alton (IL); Remote; USD 29,000 - 62,000; Full time

Benefits offered by this job

Bonus eligibility

Comprehensive benefits package

Paid time off

Job summary

CVS Health in Illinois is seeking a Case Management Coordinator to collaborate with care teams and support members with scheduling, benefits access, and education through care management tools. The role is full-time with telework and requires 50-75% travel across Northwest Illinois.

Ideal candidates have 2+ years in behavioral health or social services, strong Microsoft Office skills, and the ability to navigate benefits and care plans to improve outcomes.

Qualifications

• 2+ years experience in Behavioral Health, Social Services or appropriate related field equivalent to program focus.
• Must travel 50-75% of the time in Winnebago, Boone, Stephenson, Ogle and Jo Daviess Counties, Illinois. Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy.
• Must have 2+ years of experience of electronic documentation experience and Microsoft Office applications.

Responsibilities

• 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.

Skills

Behavioral Health

Travel readiness

Microsoft Office

Education

Bachelor's degree or non-licensed master's in Behavioral Health or Human Services

Tools

Microsoft Office

Job description

CVS Health in Illinois is seeking a Case Management Coordinator to collaborate with care teams and support members with scheduling, benefits access, and education through care management tools. The role is full-time with telework and requires 50-75% travel across Northwest Illinois.

Ideal candidates have 2+ years in behavioral health or social services, strong Microsoft Office skills, and the ability to navigate benefits and care plans to improve outcomes.