Care Management Specialist
Job Description:
- Engage telephonically with members for 50–75% of the workday and coordinate their care
- Conduct annual Health Risk Assessment Surveys
- Address members’ social determinants of health needs
- Close gaps in preventive and health maintenance care
- Use available resources to engage hard-to-reach members
- Develop individualized care plans with members, including goals and interventions
- Document care management activities in members’ electronic health records
- Collaborate with the Interdisciplinary Care Team to address barriers to care and maintain stable health conditions
- Connect members with health plan benefits and community resources
- Meet regulatory requirements within specified timelines
- Consult with the Care Manager RN regarding clinical knowledge, medication regimens, and clinical decision-making
- Support team objectives and operational efficiency
- Participate in special projects and process improvement initiatives
- Assist with mentoring new team members
Requirements:
- 2+ years of experience in a health-related field
- 2+ years of customer service experience
- Proficiency in Microsoft Office Suite: Word, Excel, Outlook, OneNote, and Teams
- Ability to effectively utilize Microsoft Office tools within the Care Manager Specialist role
- Access to a private, dedicated workspace
- Dependents must have separate care arrangements during work hours
- Experience or willingness to learn care management within Medicare and Medicaid managed care
- Familiarity with community resources and services
- Ability to navigate and use healthcare technology tools
- Effective verbal and written communication
- Excellent customer service and engagement skills
- Associate’s Degree with relevant experience in a health care-related field OR Practical Nurse Degree/Certificate with active licensure meeting state requirements (required)
- Bilingual skills, especially English-Spanish, preferred
- Experience providing care management for Medicare and/or Medicaid members preferred
- Experience with SDoH needs, chronic medical conditions, and/or behavioral health preferred
- Experience conducting health-related assessments and facilitating care planning preferred
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being, based on eligibility
