Case Management Coordinator - Field (Will County)

CVS Health•Mokena, IL

9d•$21 - $45•Hybrid

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, helps members access benefits, and provides education using care management tools and resources. Serving members enrolled in Medicare and Medicaid who may have complex health and social challenges, the coordinator works with members, providers, colleagues, and community organizations to address healthcare and social determinant needs. The coordinator evaluates member needs and eligibility, identifies risks and service needs, coordinates and monitors care plan activities, and refers members to clinical case management or crisis intervention when appropriate. The role collaborates with case managers, supervisors, Medical Directors, and other programs to resolve barriers, participates in case conferences, escalates quality-of-care issues, and supports member engagement and informed healthcare decision-making. It also applies case management and quality management processes in line with regulatory and accreditation guidelines and company policies. This is a remote-hybrid role requiring a dedicated workspace free of interruptions. Candidates must reside in Will County, Illinois, and be willing and able to travel 50–75% of the time in Will County and surrounding areas. Reliable transportation is required; mileage is reimbursed under the company expense reimbursement policy. The position is full-time, with 40 anticipated weekly hours.

Requirements

Reside in Will County, Illinois.
Be willing and able to travel 50–75% of the time in Will County and surrounding areas.
Have reliable transportation.
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.
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, and recommend approaches to case resolution or meeting those needs.
Assess members’ benefit plans and available internal and external programs and services.
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 when appropriate.
Coordinate and implement assigned care plan activities and monitor care plan progress.
Collaborate with case managers, supervisors, Medical Directors, and other health programs to overcome barriers to care goals and objectives.
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’ benefits or healthcare needs.
Use influencing and motivational interviewing skills to support member engagement and lifestyle or behavior changes.
Coach and inform members, empowering them to make independent medical and healthy lifestyle choices.
Help members participate actively and knowledgeably with providers in healthcare decision-making.
Engage in ongoing team meetings and offer peer mentoring or training.
Document and monitor care using case management and quality management processes that comply with regulatory and accreditation guidelines and company policies and procedures.