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CVS Health

Runs pharmacies, health plans and clinics

Case Management Coordinator

Case Management & AdvocacyConfirmed live in the last 24 hours
Full-timeIllinois, USA

About the Job

Requirements

  • At least 2 years of experience in behavioral health or social services.
  • Willingness and ability to travel 50–75% in Franklin, Williamson, Union, Johnson, Massac, Alexander, Pulaski and surrounding counties; reliable transportation is required.
  • At least 1 year of experience with Microsoft Office Suite applications, including Microsoft Word, Excel, Outlook and PowerPoint.
  • 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 members' needs and eligibility using care-management tools and information or data review, and recommend case-resolution approaches or ways to meet needs based on benefit plans and available 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 as 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 overcome barriers to goals and objectives; present cases at case 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 to meet members' benefits or healthcare needs.
  • Use influencing and motivational interviewing skills to support member engagement and promote lifestyle or behavior changes.
  • Coach, inform and support members so they can make ongoing independent medical and healthy-lifestyle choices.
  • Engage in ongoing team meetings and provide peer mentoring and training.
  • Help members participate actively and 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.

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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