Case Management Coordinator (Field) - (Metro East Counties, IL)

CVS Health•Fairview Heights, IL

2d•$21 - $45•Remote

About The Position

The Case Management Coordinator uses critical thinking and judgment to support the case management process and facilitate appropriate healthcare outcomes for members. The role assists with appointment scheduling, access to benefits, and member education using care management tools and resources. It evaluates members’ needs and eligibility, recommends approaches to resolve cases or meet needs, identifies high-risk factors and service needs, and refers members to clinical case management or crisis intervention when appropriate. The coordinator implements and monitors care plan activities, works with case managers and other partners to address barriers, and escalates quality-of-care issues. The position also supports member engagement and informed healthcare decisions through negotiation, motivational interviewing, coaching, information, and support. It uses case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. This is a full-time telework position requiring 50–75% travel in the Metro East Regional counties of Illinois: Madison, St. Clair, Monroe, Clinton, Jersey, Calhoun, Macoupin, and Bond. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. Central Time. Reliable transportation is required; mileage is reimbursed under the company expense reimbursement policy.

Requirements

At least 2 years of experience in behavioral health, social services, or an appropriate related field equivalent to the program focus.
Willingness and ability to travel 50–75% of the time in the Metro East area of Illinois.
Reliable transportation.
At least 2 years of electronic documentation experience.
Experience using Microsoft Office applications.
Bachelor’s degree or non-licensed master-level clinician degree in behavioral health or human services, such as psychology, social work, marriage and family therapy, or counseling.

Nice To Haves

Case management and discharge planning experience.
Managed Care experience.

Responsibilities

Evaluate members’ needs and eligibility using care management tools and information review, and recommend approaches to case resolution or meeting member needs.
Identify high-risk factors and service needs that may affect member outcomes and care planning, and refer members to clinical case management or crisis intervention as appropriate.
Coordinate and implement assigned care plan activities and monitor care plan progress.
Consult with case managers, supervisors, Medical Directors, and other health programs to address barriers to care goals.
Present cases at case conferences for multidisciplinary review and optimal outcomes.
Identify and escalate quality-of-care issues through established channels.
Use negotiation skills to secure appropriate options and services for members’ benefit and healthcare needs.
Use influencing and motivational interviewing skills to encourage member engagement and lifestyle or behavior changes.
Provide coaching, information, and support so members can make independent medical and healthy-lifestyle choices.
Help members participate actively and knowledgeably in healthcare decisions with their providers.
Participate in ongoing team meetings and provide peer mentoring or training.
Document and monitor care using case management and quality management processes in compliance with applicable guidelines and company policies.