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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. Program Summary: Join our Aetna care management team as we lead the way in providing exceptional care to dual eligible populations! You will have a life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in both Medicare and Medicaid. As a member of the care team, you will collaborate with members, the internal care team, healthcare providers, and community organizations to meet the complex healthcare and social needs of our members Be part of this exciting opportunity as we expand our DSNP services to transform lives in new markets across the country. Position Summary/Mission: As a vital member of our Special Needs Plan (SNP) care team, the Care Coordinator (CC) is responsible for coordinating care for our members through close collaboration with the Care Manager, Social Worker, and other interdisciplinary team members. This role involves evaluating member needs through the annual Health Risk Survey, addressing social determinants of health (SDoH), coordinating care across the continuum, and closing gaps in preventive and health maintenance care.
Job Responsibility:
Member Evaluation: Conduct the annual Health Risk Survey to support needs identification for the member’s Individual Plan of Care
Risk Escalation: Inform the assigned care manager of newly identified health/safety risks or service needs
Care Coordination: Complete care coordination activities delegated by the care manager within an established timeframe
Quality Issue Escalation: inform the assigned care manager and/or associate manager of any identified quality of care issues
Advocacy: Passionately support the member’s care coordination needs and drive solutions to address those needs
Member Engagement: Use problem-solving skills to find alternative contact information for members who are unreachable by care management. Employ motivational interviewing techniques to maximize member engagement and promote lifestyle changes for optimal health
Monitoring and Documentation: Adhere to case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies
Requirements:
2+ years in behavioral health, social services, or a related field relevant to the program focus
Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and capable of utilizing these tools effectively in the Care Management Coordinator role
Access to a private, dedicated space to conduct work effectively to meet the requirements of the position
Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted
High School Diploma with equivalent experience (REQUIRED)
Nice to have:
Case management and discharge planning experience
Managed care experience
Associate’s or Bachelor’s Degree or non-licensed master’s level clinician in behavioral health or human services (psychology, social work, marriage and family therapy, counseling) or equivalent experience (PREFERRED)
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