Care Manager Specialist

3 days ago


Lansing, Michigan, United States CVS Health Full time
Job Summary

Care Manager Specialist at CVS Health

Care Manager Specialist is a member of the Care Team at CVS Health. The Care Manager Specialist is responsible for the care management of members that are enrolled in the Dual Special Needs Plan and have limited health conditions. These members are usually stratified as low risk. The Care Manager Specialist will work in conjunction with the Nurse Care Manager, Care Coordinator, Transition of Care (TOC) Coach, and other members of the Care Team to improve the member's health outcomes, address social determinants of health, and connect members with community-based organizations.

Key Responsibilities
  • Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members.
  • Helps implement projects, programs, and processes for Case Management. Applies practical knowledge of Case Management to administer best-of-class policies, procedures, and plans for the area.
  • Consults with Nurse Case Managers, Supervisors, Medical Directors, and/or other members of the Care team using a holistic approach.
  • Presents cases at case conferences to obtain a 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.
  • Assists in encouraging members to actively participate with their provider in healthcare decision-making.
Requirements
  • 3+ years experience in health-related field
  • Ability to travel up to 10%
Preferred Qualifications
  • CRC, CDMS, CRRN, COHN, or CCM certification
  • Medicare and Medicaid experience
  • Managed care experience
  • Experience working with geriatric special needs, behavioral health, and disabled population
  • Knowledge of assessment, screenings, and care planning
  • Bilingual (English/Spanish; English/Creole)


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