CVS Health is hiring a remote Analyst, Case Management Specialist to serve as a telephonic Care Manager Specialist (CMS) for our Special Needs Plan (SNP). As an essential member of the care team, you will coordinate care for members, focusing on those with social determinants of health (SDoH) needs and stable health conditions. You will evaluate member needs through annual Health Risk Assessments and work to close gaps in preventative care.
What You'll Do
- Dedicate 50-75% of your day to telephonic engagement 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 with goals and interventions.
- Maintain meticulous documentation of care management activities in electronic health records.
- Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining stable health.
- Identify and connect members with health plan benefits and community resources.
- Meet regulatory requirements within specified timelines.
- Consult with the Care Manager RN for clinical knowledge, medication regimes, and supportive clinical decision making.
- Collaborate and leverage the Care Manager RN's clinical expertise to ensure members’ needs are met.
- Support team objectives, enhance operational efficiency, and ensure delivery of high-quality care.
What We're Looking For
- 2+ years of experience in a health-related field.
- 2+ years of customer service experience.
- Proficiency in the Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and ability to use these tools effectively in the role.
- Access to a private, dedicated workspace to conduct work effectively.
- An Associate’s degree and relevant experience in a health care-related field.
Nice to Have
- 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 care planning processes.
- Bilingual skills, especially English-Spanish.
- A Practical Nurse Degree/Certificate with active licensure OR a bachelor's degree in health care or a related field.
Technical Stack
- Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams)
Team & Environment
You will collaborate closely with the Registered Nurse Care Manager, Care Coordinator, Social Worker, and other interdisciplinary care team participants.
Benefits & Compensation
- Hourly compensation: $21.10 - $40.90
- Affordable medical plan options
- 401(k) plan with matching company contributions
- Employee stock purchase plan
- No-cost wellness screenings, tobacco cessation and weight management programs, confidential counseling, and financial coaching
- Paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access
Work Mode
This position is fully remote.
CVS Health is an equal opportunity employer. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
