Case Management Specialist

This is a fully remote position, open to applicants in Connecticut, +8 more states.

📋 Description

• Engage with members via telephone for 50–75% of the workday.

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

• Complete annual Health Risk Assessment Surveys.

• Address social determinants of health needs and close gaps in preventive and health maintenance care.

• Conduct outreach to members who are difficult to reach using available resources.

• Develop personalized care plans with members, including specific goals and interventions.

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

• Collaborate with the Interdisciplinary Care Team to overcome barriers to care and ensure members maintain stable health.

• Connect members with health plan benefits and community resources.

• Meet regulatory requirements within designated timelines.

• Consult with and utilize the clinical expertise of the Care Manager RN regarding clinical knowledge, medication regimens, and supportive clinical decision-making.

• Support team goals and enhance operational efficiency.

• Participate in special projects and initiatives aimed at process improvement.

• Assist in mentoring new team members.

⛳️ Requirements

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

• At least 2 years of customer service experience.

• Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams.

• Capability to effectively utilize Microsoft Office tools as a Case Management Specialist.

• An Associate’s degree along with relevant experience in a healthcare-related field (required).

• Access to a private and dedicated workspace.

• Direct/hardwired internet connection to a modem/router within 7 feet of the computer.

• Minimum internet speeds of 25 Mbps download and 3 Mbps upload.

• WiFi and satellite internet connections are not allowed.

• A quiet, secure, and private home work environment that complies with CVS Health and HIPAA standards.

• Must reside and work within the state and city of current residence.

• A Practical Nurse Degree/Certificate with active licensure meeting state requirements or a bachelor’s degree in healthcare or a related field (preferred).

• Experience or eagerness to learn about care management within Medicare and Medicaid managed care.

• Familiarity with community resources and services.

• Ability to navigate healthcare technology tools effectively.

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

• Strong verbal and written communication skills.

• Excellent customer service and engagement abilities.

• Previous experience providing care management for Medicare and/or Medicaid members (preferred).

• Background working with individuals with 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).

• Proficiency in using multiple monitors and applications simultaneously.

• Familiarity with Microsoft Office 365 applications or similar tools like Google Workspace.

• Ability to utilize secure systems such as VPN and EHR portals.

• Competence in managing strong passwords and identifying suspicious emails or links.

• Ability to troubleshoot common technical issues independently.

• Willingness to learn new skills as the workplace evolves.

🏝️ 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 promoting physical, emotional, and financial well-being.

• Company-provided equipment, including keyboard, monitor, computer, and headset.

• Opportunity to work remotely from a designated home workspace.