This is a remote position that requires 50-75% of travel in Iroquois or Vermillion County of IL and surrounding areas. Preference to candidates that reside in these counties, but may also reside in surrounding counties. Schedule standard business hours, Monday-Friday 8:00am-5:00pm.
As a Case Management Coordinator you will facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources.
Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate
appropriate healthcare outcomes for members by
providing care coordination, support and education for
members through the use of care management tools and
Evaluation of Members:
- Through the use of 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.
Enhancement of Medical Appropriateness and Quality of Care:
- 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 in order 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
- 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.
Monitoring, Evaluation and Documentation of Care:
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
- Minimum of 2 years of experience in behavioral health or social services field required.
- 2+ years of case management experience required.
- Willing and able to travel using your own vehicle 50-75% of their time to meet with members face to face in Iroquois or Vermillion County of IL and surrounding areas.
- Valid Drivers License required.
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
- Discharge planning experience preferred.
- Managed Care experience preferred.
- Microsoft Office experience preferred.
- Bachelor's degree required with either degree being in behavioral health or human services (psychology, social work, marriage and family therapy, counseling)
- Non-licensed master level clinician preferred with either degree being in behavioral health or human services (psychology, social work, marriage and family therapy, counseling)
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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