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About the Role

As an essential member of our Special Needs Plan (SNP) care team, the telephonic Care Manager Specialist (CMS) plays a key role in coordinating the care of our members, particularly those with social determinants of health (SDoH) needs and stable health conditions. The CMS collaborates closely with the Registered Nurse Care Manager, Care Coordinator, Social Worker, and other interdisciplinary care team participants to support the member in maintaining optimal health.

Responsibilities

Dedicate 50-75% of the day to engaging 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 that encompass goals and interventions to meet their identified needs.
Maintain meticulous documentation of care management activities in the member’s electronic health record.
Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
Identify and connect members with health plan benefits and community resources.
Meet regulatory requirements within specified timelines.
Consults with the Care Manager RN within the Care Team for clinical knowledge, medication regimes, and supportive clinical decision making.
Collaborates and leverages the Care Manager RN clinical expertise to ensure members’ needs are adequately addressed.
Support team objectives, enhance operational efficiency, and ensure delivery of high-quality care to members.
Participate in special projects, contribute to process improvement initiatives, or assist with mentoring new team members.

Requirements

2+ years of experience in a health-related field
2+ years of customer service experience
Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and ability to effectively utilize these tools within the Case Management Specialist (CMS) role
Access to a private, dedicated space to conduct work effectively to meet the requirements of the position
Experience providing care management for Medicare and/or Medicaid members (Preferred)
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health (Preferred)
Experience conducting health-related assessments and facilitating the care planning processes (Preferred)
Bilingual skills, especially English-Spanish (Preferred)
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Skills

Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements.
Conduct oneself with integrity, professionalism, and self-direction.
Experience or willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care.
Familiarity with community resources and services.
Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
Maintain strong collaborative and professional relationships with members and colleagues.
Communicate effectively, both verbally and in writing.
Excellent customer service and engagement skills.

Work Type

Full time

Education Level

Associate’s Degree AND relevant experience in a health care-related field OR Practical Nurse Degree/Certificate with active licensure that meets state requirements (REQUIRED)
Bachelor’s Degree in health care or a related field (PREFERRED)

Salary/Compensations

$21.10 - $40.90

Benefits

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources, based on eligibility

About the Company

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience.
At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Our people fuel our future.
Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.