Job Description:

• Engage telephonically with members for 50–75% of the workday
• Coordinate care for Special Needs Plan members, particularly those with social determinants of health needs and stable health conditions
• Complete annual Health Risk Assessment Surveys
• Address social determinants of health needs and close preventive and health maintenance care gaps
• Conduct outreach to hard-to-reach members using available resources
• Develop individualized care plans with members, including goals and interventions
• Document care management activities in members’ electronic health records
• Collaborate with the Interdisciplinary Care Team to address barriers to care and maintain members’ stable health
• Connect members with health plan benefits and community resources
• Meet regulatory requirements within specified timelines
• Consult with and leverage the Care Manager RN’s clinical expertise for clinical knowledge, medication regimens, and supportive clinical decision-making
• Support team objectives and operational efficiency
• Participate in special projects and process improvement initiatives
• Assist with mentoring new team members

Requirements:

• 2+ years of experience in a health-related field
• 2+ years of customer service experience
• Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams
• Ability to effectively use Microsoft Office tools within the Case Management Specialist role
• Associate’s degree and relevant experience in a health care-related field (required)
• Access to a private, dedicated workspace
• Direct/hardwired internet connection to a modem/router within 7 feet of the computer
• Minimum internet speed of 25 Mbps download and 3 Mbps upload
• WiFi and satellite internet are not permitted
• Quiet, secure, private home work location compliant with CVS Health and HIPAA guidelines
• Must work within the state and city where currently living
• Practical Nurse Degree/Certificate with active licensure meeting state requirements or bachelor’s degree in health care or related field (preferred)
• Experience or willingness to learn care management within Medicare and Medicaid managed care
• Familiarity with community resources and services
• Ability to navigate healthcare technology tools
• Ability to meet performance, productivity, call volume, member engagement, and regulatory metrics
• Effective verbal and written communication skills
• Excellent customer service and engagement skills
• Experience providing care management for Medicare and/or Medicaid members (preferred)
• Experience with individuals with SDoH needs, chronic medical conditions, and/or behavioral health (preferred)
• Experience conducting health-related assessments and facilitating care planning (preferred)
• Bilingual skills, especially English-Spanish (preferred)
• Ability to use multiple monitors and applications simultaneously
• Experience with Microsoft Office 365 applications or similar tools such as Google Workspace
• Ability to use secure systems such as VPN and EHR portals
• Ability to manage strong passwords and recognize suspicious emails or links
• Ability to troubleshoot common technical issues independently
• Openness to learning new skills as the workplace evolves

Benefits:

• CVS Health bonus, commission or short-term incentive program in addition to base pay
• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being
• Company-provided equipment, including keyboard, monitor, computer, and headset
• Remote work from a designated home workspace