Case Management Specialist

CVS Health•Work At Home-Pennsylvania, SC

18h•$21 - $41•Remote

About The Position

As an essential member of our Special Needs Plan (SNP) care team, the telephonic Care Manager Specialist (CMS) plays a key role in coordinating the care of our members, particularly those with social determinants of health (SDoH) needs and stable health conditions. The CMS collaborates closely with the Registered Nurse Care Manager, Care Coordinator, Social Worker, and other interdisciplinary care team participants to support the member in maintaining optimal health. This is achieved by evaluating the members’ needs through the completion of the annual Health Risk Assessment Survey, addressing SDoH needs, and closing gaps in preventative and health maintenance care.

Requirements

2+ years of experience in a health-related field
2+ years of customer service experience
Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and ability to effectively utilize these tools within the Case Management Specialist (CMS) role
Access to a private, dedicated space to conduct work effectively to meet the requirements of the position
Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
Openness to learning new skills in the future as the workplace environment evolves
Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
Commitment to obtaining required internet speeds and adhere to all Work From Home requirements.

Nice To Haves

Experience providing care management for Medicare and/or Medicaid members
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health
Experience conducting health-related assessments and facilitating the care planning processes
Bilingual skills, especially English-Spanish
Practical Nurse Degree/Certificate with active licensure that meets state requirements OR bachelor’s degree in health care or a related field

Responsibilities

Dedicate 50-75% of the day to engaging with members and coordinating their care.
Utilize all available resources to connect with and engage “hard-to-reach” members.
Partner with members to develop individualized care plans that encompass goals and interventions to meet their identified needs.
Maintain meticulous documentation of care management activities in the member’s electronic health record.
Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
Identify and connect members with health plan benefits and community resources.
Meet regulatory requirements within specified timelines.
Consults with the Care Manager RN within the Care Team for clinical knowledge, medication regimes, and supportive clinical decision making.
Collaborates and leverages the Care Manager RN clinical expertise to ensure members’ needs are adequately addressed.
Support team objectives, enhance operational efficiency, and ensure delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.