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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.
Job Responsibility:
Utilizes critical thinking and judgment to collaborate and inform the case management process, to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources
Using care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services
Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate
Coordinates and implements assigned care plan activities and monitors care plan progress
Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives
presents cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes
Identifies and escalates quality of care issues through established channels
Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/ behavior changes to achieve optimum level of health
Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
Helps member actively and knowledgably participate with their provider in healthcare decision-making
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
Requirements:
Degree in Health Care/Human Services related field
Case Management Experience
Strong customer service orientation and problem solving skills
Excellent communication/telephonic skills
Excellent motivational interviewing skills/ability to build rapport and trust telephonically
Excellence in documentation and respecting compliance/regulatory standards
Highly organized, remain self-driven without direct supervision
Manage time effectively
Achieve performance metrics
Technology proficiency
Ability to travel within 125 miles round trip for 1 day in the field
Variable work scheduled with ability to work 2 days weekly until 9pm local time
Nice to have:
Bachelors and/or Master's Degree
CCM certification
Previous experience in managed care organization
What we offer:
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching