Care Management Specialist

This is a fully remote position, open to applicants in Florida.

📋 Description

• Conduct phone interactions with members for 50–75% of the workday.

• Coordinate care for members of the Special Needs Plan, especially those with social determinants of health considerations and stable health conditions.

• Complete annual Health Risk Assessment Surveys.

• Identify and address needs related to social determinants of health.

• Close gaps in preventive care and health maintenance.

• Utilize available resources to engage members who are hard to reach.

• Create personalized care plans in collaboration with members.

• Document care management activities in members’ electronic health records.

• Work together with the Interdisciplinary Care Team to tackle barriers to care.

• Connect members to health plan benefits and community resources.

• Comply with regulatory requirements within designated timelines.

• Consult with the Care Manager RN to leverage clinical expertise.

• Support team goals and operational efficiency.

• Engage in special projects and initiatives for process improvement.

• Assist in mentoring new team members.

⛳️ Requirements

• Minimum of 2 years of experience in a health-related field.

• At least 2 years of customer service experience.

• Proficient in Microsoft Office Suite: Word, Excel, Outlook, OneNote, and Teams.

• Ability to effectively utilize healthcare technology tools.

• Access to a private and dedicated workspace.

• Dependents must have alternative care arrangements during work hours.

• Associate’s Degree with relevant experience in a healthcare-related field OR a Practical Nurse Degree/Certificate with active licensure that meets state requirements (REQUIRED).

• Experience or a willingness to learn care management within Medicare and Medicaid managed care.

• Familiarity with community resources and services.

• Strong verbal and written communication skills.

• Exceptional customer service and engagement abilities.

• Capacity to meet performance, productivity, call volume, member engagement, and regulatory metrics.

• Bachelor’s Degree in healthcare or a related field (PREFERRED).

• Experience in providing care management for Medicare and/or Medicaid members (PREFERRED).

• Background in SDoH needs, chronic medical conditions, and/or behavioral health (PREFERRED).

• Experience conducting health-related assessments and facilitating care planning (PREFERRED).

• Bilingual skills, particularly in English and Spanish (PREFERRED).

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being, based on eligibility.