Engage telephonically with members for 50–75% of the day and coordinate their care
Conduct annual Health Risk Assessment Surveys
Identify and address social determinants of health needs
Close gaps in preventive and health maintenance care
Use available resources to connect with and engage hard-to-reach members
Partner with members to develop individualized care plans with 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 and leverage the Care Manager RN’s clinical expertise for clinical knowledge, medication regimens, and supportive 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
Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams)
Ability to effectively utilize Microsoft Office tools within the Care Manager Specialist role
Access to a private, dedicated space to conduct work effectively
Dependents must have separate care arrangements during work hours; continuous care responsibilities during shift times are not permitted
Associate’s Degree with relevant experience in a health care-related field OR Practical Nurse Degree/Certificate with active licensure that meets state requirements (REQUIRED)
Experience providing care management for Medicare and/or Medicaid members
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health
Experience conducting health-related assessments and facilitating care planning processes
Bilingual skills, especially English-Spanish
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