Case Management Coordinator - Field (Winnebago, Boone and Jo Daviess Counties, IL)

CVS Health•Chicago, IL

2d•Remote

About The Position

CVS Health is hiring a Case Management Coordinator for a full-time telework position serving members in Northwest Illinois, with 50–75% travel in and around Winnebago, Boone, Stephenson, Ogle, and Jo Daviess counties. The schedule is standard business hours, Monday through Friday, 8:00 a.m. to 5:00 p.m. CST. The role uses critical thinking and judgment to support the case management process and help members achieve appropriate healthcare outcomes. The coordinator assists with appointment scheduling, benefit access, and member education using care management tools and resources. The coordinator evaluates members’ needs and eligibility, recommends approaches to resolving cases or meeting needs, identifies risks and service needs, and coordinates assigned care plan activities. The role works with case managers, supervisors, Medical Directors, and other programs to address barriers to care, participates in multidisciplinary case conferences, escalates quality-of-care concerns, and uses negotiation, motivational interviewing, and coaching to support member engagement and informed healthcare decisions. Case management and quality management work must comply with regulatory and accreditation guidelines and company policies and procedures.

Requirements

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.
Willingness and ability to travel 50–75% of the time in Winnebago, Boone, Stephenson, Ogle, and Jo Daviess counties in Illinois.
Reliable transportation.
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 or meeting members’ needs by evaluating 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 make appropriate referrals to clinical case management or crisis intervention.
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 goals and objectives.
Present cases at conferences to obtain multidisciplinary review and support optimal outcomes.
Identify and escalate quality-of-care issues through established channels.
Negotiate to secure appropriate options and services to meet members’ benefits or 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.
Participate in ongoing team meetings and offer peer mentoring or training.
Help members participate knowledgeably with their providers in healthcare decision-making.
Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Assist members with appointment scheduling, benefits access, and education.
Travel 50–75% of the time in the designated Illinois counties.