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CVS Health

Runs pharmacies, health plans and clinics

Case Management Coordinator

Medical, Clinical & VeterinaryUpdated on Nov 10
Full-timeIllinois, USA$21.10 - $44.99

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.
  • At least 2 years of electronic documentation experience and experience using Microsoft Office applications.
  • Must be willing and able to travel 50–75% of the time in the Metro East area of Illinois; reliable transportation is required.
  • A bachelor's degree or a non-licensed master's-level clinician degree in behavioral health or human services, such as psychology, social work, marriage and family therapy, or counseling, is required.

Responsibilities

  • Evaluate member 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 components, and make appropriate referrals to clinical case management or crisis intervention.
  • 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; present cases at 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 needed to meet members’ benefits or healthcare needs.
  • Use influencing and motivational interviewing skills to support member engagement and promote lifestyle or behavior changes for optimal health.
  • Provide coaching, information, and support to empower members to make ongoing independent medical and healthy lifestyle choices.
  • Participate in ongoing team meetings and provide peer mentoring and training.
  • Help members participate actively and knowledgeably with their providers in healthcare decision-making.
  • Monitor, evaluate, and document care using 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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