Case Management Coordinator - Field (Cook County, IL)

CVS Health•Oak Park, IL

1d•$21 - $45

About The Position

The Case Management Coordinator uses critical thinking and judgment to collaborate on and inform the case management process. The role helps members achieve appropriate healthcare outcomes by assisting with appointment scheduling, access to benefits, and education through care management tools and resources. The coordinator evaluates members’ needs and eligibility using care management tools and data, reviews benefit plans and available programs, identifies high-risk factors and service needs, and refers members to clinical case management or crisis intervention when appropriate. The role coordinates assigned care plan activities and monitors progress. Working with case managers, supervisors, Medical Directors, and other health programs, the coordinator helps overcome barriers to care and presents cases for multidisciplinary review. The coordinator identifies and escalates quality-of-care issues, negotiates appropriate services, uses motivational interviewing to engage members, provides coaching and support, and helps members participate knowledgeably in healthcare decisions. The position also involves team meetings, peer mentoring and training, and documenting care in accordance with regulatory, accreditation, and company requirements. The candidate must reside in Cook County, Illinois, and be willing and able to travel 50–75% of the time in Cook County and surrounding areas. Reliable transportation is required; mileage is reimbursed under the company’s expense reimbursement policy. This is a full-time position with 40 anticipated weekly hours.

Requirements

Must reside in Cook County, Illinois.
Must be willing and able to travel 50–75% of the time in Cook County and surrounding areas.
Reliable transportation is required.
At least 2 years of experience in behavioral health, social services, or an appropriate related field equivalent to the program focus.
At least 2 years of electronic documentation experience.
Experience with Microsoft Office applications.
A bachelor’s degree or non-licensed master-level clinician qualification 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 or data review.
Recommend approaches to case resolution and meeting member needs by assessing benefit plans and available internal and external programs or services.
Identify high-risk factors and service needs that may affect member outcomes and care planning.
Refer members to clinical case management or crisis intervention when appropriate.
Coordinate assigned care plan activities and monitor care plan progress.
Consult with case managers, supervisors, Medical Directors, and other health programs to overcome barriers to care.
Present cases at case conferences for multidisciplinary review and optimal outcomes.
Identify and escalate quality-of-care issues through established channels.
Negotiate appropriate options and services to meet members’ benefits and healthcare needs.
Use influencing and motivational interviewing skills to engage members and support lifestyle or behavior changes.
Provide coaching, information, and support to empower members to make independent medical and healthy lifestyle choices.
Help members participate actively and knowledgeably in healthcare decision-making with their providers.
Participate in ongoing team meetings and offer peer mentoring or training.
Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Travel 50–75% of the time in Cook County and surrounding areas.