Case Management Coordinator – Field – Must reside in Rockford Illinois

CVS Health • Rockford, IL

1d • $21 - $45

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
As a Case Management Coordinator you will facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. Travel: 50-75% travel required . Evaluation of Members: -Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identifies 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 appropriate. - Coordinates and implements assigned care plan activities and monitors care plan progress. Enhancement of Medical Appropriateness and Quality of Care: - Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain 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. -Helps member actively and knowledgeably participate with their provider in healthcare decision-making. Monitoring, Evaluation and Documentation of Care: - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

• Minimum 2 years of experience in behavioral health, social services or human services field.
• Minimum 2 years of case Management experience.
• Must reside in Rockford IL.
• Must have a valid IL Drivers License.
• Willing and able to travel up to 50- 75% of the time to meet members face to face in Rockford, IL and surrounding areas.
• Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policy
• Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services required (psychology, social work, marriage and family therapy, counseling)

Nice To Haves

• Discharge planning experience
• Managed Care experience
• Microsoft Office experience

Responsibilities

• Conducts comprehensive evaluation of referred member’s needs/eligibility
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives
• Presents cases at case conferences to obtain 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.
• Helps member actively and knowledgeably participate with their provider in healthcare decision-making.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level