Analyst, Case Management Specialist

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.

Job Purpose and Summary :

The Care Manager is a member of the Care Team. The Care Manager is responsible for the care management of members that are enrolled in the Dual Special Needs Plan and have limited health conditions.

These members are usually stratified as low risk. The Care Manager will work in conjunction with the Nurse Care Manager, Care Coordinator, Transition of Care (TOC) Coach, and other members of the Care Team to improve the member’s health outcomes, address social determinants of health and connect members with community based organizations.

The Care Manager will assess member’s needs as well as gaps in care, communicate with the member’s Primary Care Provider (PCP), maintain updated individualized care plans and participate in Interdisciplinary team meetings.

Care Managers will be able to identify members who’s needs require clinician involvement and transition members appropriately.

Responsibilities :

• Responsible for interacting with low stratification members via phone calls, coordinating care, completing, reviewing, and updating assessments and care plans that address problems, goals and interventions.
• Based on assessments and claims data creates a care plan for members to follow
• Participate as a member of the Care Team during Interdisciplinary Team meetings to discuss the member’s health care needs, barriers to care and explore better outcomes for the member
• Identify and link members with health plan benefits and community resources Perform administrative work to maintain skills needed for job duties

Essential Qualifications and Functions :

• Regular and reliable attendance
• Familiar with community resources & services
• Strong organizational skills
• Works independently
• Maintains professional relationships with the members we serve as well as colleagues
• Communicates effectively and professionally verbally and in writing
• Proficient with computer systems
• Knowledgeable in Microsoft Office Software
• Excellent customer service skills
• Has a dedicated home work space

Required Qualifications :

• 3+ years experience in health-related field
• 2+ years of customer service experience
• 2+ years of experience with claims

Preferred Qualifications :

• CRC, CDMS, CRRN, COHN, or CCM certification
• Medicare and Medicaid experience
• Managed care experience
• Experience working with geriatric special needs, behavioral health and disable population
• Knowledge of assessment, screenings and care planning
• Bilingual (English / Spanish; English / Creole)

Education :

Bachelors Degree or equivalent experience required

Pay Range

The typical pay range for this role is :

$19.52 - $40.90

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.

The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.

The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.

The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits.

CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.

As for time off, Company employees enjoy Paid Time Off ( PTO ) or vacation pay, as well as paid holidays throughout the calendar year.

Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.