Case Management Specialist

This is a fully remote position, open to applicants in Florida, +4 more states.

📋 Description

• Interact with members via telephone for 50–75% of the workday while coordinating their care.

• Perform member outreach utilizing available resources to engage those who are hard to reach.

• Conduct annual Health Risk Assessment Surveys.

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

• Create personalized care plans with members, outlining goals and interventions.

• Record care management activities in the electronic health records of members.

• Work collaboratively with the Interdisciplinary Care Team to tackle barriers to care and sustain stable health conditions.

• Connect members with health plan benefits and community resources.

• Comply with regulatory requirements within designated timelines.

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

• Contribute to team goals and enhance operational efficiency.

• Engage in special projects and process improvement initiatives.

• Assist in mentoring new team members.

⛳️ Requirements

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

• Minimum of 2 years of customer service experience.

• Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams).

• Capability to effectively use Microsoft Office tools within the Care Manager Specialist position.

• Access to a private and dedicated workspace to perform duties effectively.

• Dependents must have separate arrangements for care during working hours.

• An Associate’s Degree along with relevant experience in a healthcare-related field is required.

• Experience or a strong willingness to learn about care management in Medicare and Medicaid managed care.

• Familiarity with community resources and services.

• Proficient in navigating and utilizing healthcare technology tools.

• Ability to meet performance and productivity standards.

• Strong verbal and written communication skills.

• Excellent customer service and engagement abilities.

• Preferred: Experience in providing care management for Medicare and/or Medicaid members.

• Preferred: Experience with individuals facing SDoH needs, chronic medical conditions, and/or behavioral health issues.

• Preferred: Experience in conducting health-related assessments and facilitating care planning.

• Preferred: Bilingual skills, especially in English and Spanish.

• Practical Nurse Degree/Certificate with active licensure that meets state requirements OR a Bachelor’s Degree in healthcare or a related field is preferred.

🏝️ Benefits

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

• 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.