Healthcare Case Manager

4 days ago


Vernon Hills, Illinois, United States CVS Health Full time
Job Summary

CVS Health is seeking a skilled Case Management Coordinator to facilitate healthcare outcomes for members by providing care coordination, support, and education through the use of care management tools and resources.

Key Responsibilities
  • Conduct comprehensive evaluations of referred members' needs and eligibility, recommending approaches to case resolution and/or meeting needs by evaluating members' benefit plans and available internal and external programs/services.
  • Identify high-risk factors and service needs that may impact member outcomes and care planning components, referring to clinical case management or crisis intervention as appropriate.
  • Coordinate and implement assigned care plan activities and monitor care plan progress.
  • Enhance medical appropriateness and quality of care by consulting 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 members' benefits and/or healthcare needs.
  • Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum levels of health.
  • Provide coaching, information, and support to empower members to make ongoing independent medical and/or healthy lifestyle choices.
  • Help members actively and knowledgeably participate with their providers in healthcare decision-making.
Requirements
  • Minimum 2 years of experience in behavioral health, social services, or human services field.
  • Minimum 2 years of case management experience.
  • Willing and able to travel using own vehicle up to 50-75% of the time to meet members face-to-face in Lake County, IL, and surrounding areas.
  • Reliable transportation required; mileage is reimbursed per company expense reimbursement policy.
Preferred Qualifications
  • Discharge planning experience.
  • Managed Care experience.
  • Microsoft Office experience.
Education

Bachelor's degree or licensed master-level clinician required, with either degree being in behavioral health or human services required (e.g., psychology, social work, marriage and family therapy, counseling).

Pay Range

The typical pay range for this role is $42.91 per hour. 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.



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