Remote Case Manager & Social Worker - Care Coordination

Preferra Insurance; Warren (MI); Remote; USD 47,000 - 101,000; Full time

Job summary

CVS Health is seeking a skilled Care Coordinator to manage cases for members with long-term rehabilitation and psychosocial needs, coordinating services to prevent readmissions and ensure quality of life. This role involves collaborating with providers, home care teams, and community resources across the continuum of care.

You will assess members, develop individualized care plans, educate on available services, and lead initiatives to reduce hospitalizations while supporting diverse

Qualifications

• Minimum 2 years experience in medical social work or case management.
• Must travel up to 25%-50% in Wayne and Macomb Counties with reliable transportation.
• Complies with all state requirements in the state where job duties are performed.
• Basic awareness of problem solving and decision making skills.
• Basic awareness of digital literacy skills.
• Basic knowledge of medical terminology.
• Ability to deal tactfully with customers and community.
• Ability to handle sensitive information ethically and responsibly.
• Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option.
• Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients.

Responsibilities

• Controls comprehensive management of members with acute or chronic conditions, focusing on quality of care, outcomes and decreasing costs for individuals and communities.
• Implements initial and periodic assessments of the members enrolled in the Long-Term Care Program and/or case or disease management programs under limited supervision to determine course of treatment.
• Applies in-depth knowledge of case management concepts, principles, and strategies in the development of an individualized case plan for enrolled members in case or disease management that are at risk of poor outcomes.
• Communicates updates and facilitates discussion with providers, primary care physicians, Medical Directors, pharmacists, and care management staff regarding the status of patients internally and externally.
• Identifies opportunities to ensure the member receives all the necessary care allowed under the member's benefit plan in home or community settings.
• Provides information, resources, and education on social issues, mental health, and available services to raise awareness and empower individuals and communities.
• Develops complex, innovative programs designed to reduce admissions for acute and chronic members, increase community integration, and improve health outcomes for enrolled patients and outside individuals.
• Coaches more junior colleagues in techniques, processes, and responsibilities of social work to improve capacity.
• Collaborates with community members, organizations, and policymakers to create opportunities for clients, address community issues, or raise awareness for specific issues.

Skills

Case management

Social work

Travel up to 25-50%

Digital literacy

Medical terminology

Customer service

Ethical handling of sensitive info

Problem solving

Education

Bachelor's Degree in Social Work

LLBSW

LBSW

LLMSW

Job description

CVS Health is seeking a skilled Care Coordinator to manage cases for members with long-term rehabilitation and psychosocial needs, coordinating services to prevent readmissions and ensure quality of life. This role involves collaborating with providers, home care teams, and community resources across the continuum of care.

You will assess members, develop individualized care plans, educate on available services, and lead initiatives to reduce hospitalizations while supporting diverse