Case Management Coordinator
1 day ago
At CVS Health, we're committed to delivering exceptional patient care and outcomes. As a Case Management Coordinator, you'll play a vital role in our mission to make healthcare more personal, convenient, and affordable.
Program OverviewOur Dual Eligible Special Needs Plan (DSNP) is designed to serve Medicare and Medicaid members with complex health and social challenges. As a Case Management Coordinator, you'll collaborate with members, providers, and community organizations to address their full continuum of healthcare and social determinant needs.
Position Summary/MissionThe Case Management Coordinator utilizes critical thinking and judgment to inform the case management process, ensuring appropriate healthcare outcomes for members. You'll provide assistance with appointment scheduling, identify and assist with accessing benefits, and educate members through the use of care management tools and resources.
Fundamental Components- Evaluation of Members: Conduct comprehensive evaluations of referred members' needs/eligibility, recommending an approach to case resolution and/or meeting needs by evaluating member benefits and available internal and external programs/services.
- Identify 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 needed.
- Coordinate and implement assigned care plan activities and monitor care plan progress.
- Enhancement of Medical Appropriateness and Quality of Care: Utilize 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 to achieve optimal outcomes.
- Identify and escalate quality of care issues through established channels.
- Utilize negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
- Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
- Provide coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Help members actively and knowledgeably participate with their provider in healthcare decision-making.
- Monitoring, Evaluation, and Documentation of Care: Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
- Case management and discharge planning experience preferred.
- 2 years of experience in behavioral health, social services, or an appropriate related field equivalent to program focus.
- Managed Care experience preferred.
- Bachelor's degree or non-licensed master-level clinician with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling) or equivalent experience.
The typical pay range for this role is $40.90. 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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ('PTO') or vacation pay, as well as paid holidays throughout the calendar year.
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