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 Overview:
Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.
Position Summary/Mission: The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, The Case Management Coordinator facilitates appropriate healthcare outcomes for members by aiding with appointment scheduling, identifying and assisting with accessing benefits and
education for members through the use of care management tools and resources.
Key Responsibilities
•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 health.
•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.
Remote Work Expectations
•Candidates must have a dedicated workspace free of interruptions
•Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.
• Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services.
Required Qualifications
•Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services required (nursing, psychology, social work, marriage and family therapy, counseling).
• Ability to travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise
•Must have computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.
Preferred Qualifications
•Case management and discharge planning experience preferred
•2 years’ experience in behavioral health, social services or appropriate related field equivalent to program focus
•Managed Care experience preferred
•Effective communication, telephonic and organization skills
•Excellent analytical and problem-solving skills
•Ability to work independently
•Ability to effectively participate in a multi-disciplinary team including internal and external participants.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$21.10 - $44.99This 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.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- Bachelor's degree in behavioral health or human services
- Ability to travel within a designated geographic area for in-person activities
- Computer literacy to navigate internal/external systems
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Healthcare coverage is positioned as comprehensive for benefits-eligible colleagues, including medical, dental, and vision with free preventive care and access to virtual care and select no-cost MinuteClinic services. Mental health support is also highlighted with no-cost confidential counseling sessions per issue.
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Retirement Support — Retirement benefits include a 401(k) with a dollar-for-dollar match up to 5% after meeting service and hours requirements. Ownership programs are also offered through an employee stock purchase plan with a stated purchase discount.
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Pay Growth & Progression — A companywide minimum wage floor establishes a baseline that is framed as a positive starting point in some roles and markets. Unionized or high-cost areas are described as having clearer wage scales and step-ups that can materially lift pay over time.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
