Care Management Specialist

CVS Health

1d•Remote

About The Position

As an essential member of our Special Needs Plan (SNP) care team, the telephonic Care Manager Specialist (CMS) plays a key role in coordinating the care of our members, particularly those with social determinants of health (SDoH) needs and stable health conditions. The CMS collaborates closely with the Registered Nurse Care Manager, Care Coordinator, Social Worker, and other interdisciplinary care team participants to support the member in maintaining optimal health. This is achieved by evaluating the members’ needs through the completion of the annual Health Risk Assessment Survey, addressing SDoH needs, and closing gaps in preventative and health maintenance care.

Requirements

2+ years of experience in a health-related field
2+ years of customer service experience
Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and ability to effectively utilize these tools within the Care Manager Specialist role
Access to a private, dedicated space to conduct work effectively to meet the requirements of the position
Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.
Associate’s Degree AND relevant experience in a health care-related field (REQUIRED)

Nice To Haves

Experience providing care management for Medicare and/or Medicaid members
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health
Experience conducting health-related assessments and facilitating the care planning processes
Bilingual skills, especially English-Spanish
Practical Nurse Degree/Certificate with active licensure that meets state requirements OR Bachelor’s Degree in health care or a related field (PREFERRED)

Responsibilities

Dedicate 50-75% of the day to engaging with members and coordinating their care.
Utilize all available resources to connect with and engage “hard-to-reach” members.
Partner with members to develop individualized care plans that encompass goals and interventions to meet their identified needs.
Maintain meticulous documentation of care management activities in the member’s electronic health record.
Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
Identify and connect members with health plan benefits and community resources.
Meet regulatory requirements within specified timelines.
Consults with the Care Manager RN within the Care Team for clinical knowledge, medication regimes, and supportive clinical decision making.
Collaborates and leverages the Care Manager RN clinical expertise to ensure members’ needs are adequately addressed.
Support team objectives, enhance operational efficiency, and ensure delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.