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CVS Health

Runs pharmacies, health plans and clinics

Case Management Coordinator

Case Management & AdvocacyUpdated on Nov 10
Full-time

About the Job

Requirements

  • At least 2 years of experience in Behavioral Health, Social Services, or an appropriate related field equivalent to the program focus.
  • Must be willing and able to travel 50–75% of the time in DuPage, Kane, DeKalb, and Kendall Counties, Illinois, and have reliable transportation.
  • At least 2 years of electronic documentation experience and experience with Microsoft Office applications.
  • A bachelor's degree or non-licensed master's-level clinician qualification in Behavioral Health or Human Services, such as Psychology, Social Work, Marriage and Family Therapy, or Counseling.

Responsibilities

  • Evaluate members' needs and eligibility using care management tools and information/data review, and recommend approaches to case resolution or meeting 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 refer members to clinical case management or crisis intervention when appropriate.
  • Coordinate and implement assigned care plan activities and monitor care plan progress.
  • Consult with case managers, supervisors, Medical Directors, and other health programs to address barriers to goals and objectives, and present cases at case conferences for multidisciplinary review.
  • Identify and escalate quality-of-care issues through established channels.
  • Use negotiation skills to secure options and services that meet members' benefits or healthcare needs.
  • Use influencing and motivational interviewing skills to maximize member engagement and promote lifestyle or behavior changes.
  • Provide coaching, information, and support to help members make independent medical and healthy lifestyle choices.
  • Participate in ongoing team meetings and provide peer mentoring and training.
  • Help members actively and knowledgeably participate in healthcare decision-making with their providers.
  • Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Desired Qualifications

  • Case management and discharge planning experience.
  • Managed care experience.

About the Company

CVS Health

Runs pharmacies, health plans and clinics

CVS Health runs pharmacies, health insurance plans and medical clinics for individuals, employers and government programs across the United States. Its businesses include CVS Pharmacy, the Aetna insurer and Caremark, which manages prescription coverage and negotiates drug prices for health plans. Patients fill prescriptions in stores or by mail and receive care through walk-in clinics, primary care centers and home visits. The company earns money from prescription sales, insurance premiums, plan administration fees and clinical services, combining coverage with places to obtain treatment. Its first store opened in 1963, and its headquarters are in Woonsocket, Rhode Island.

Company size
10,001+
Company stage
IPO
Headquarters
Woonsocket, Rhode Island
Founded
1963

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