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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.
Position Summary
Schedule is standard business hours, Monday through Friday 8:30am-5:00pm EST.
Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. Helps implement projects, programs, and processes for Case Management. Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area.
Consults with case managers, supervisors, medical directors and/or other health programs using a holistic approach, to overcome barriers to meeting goals and objectives.
Presents cases at case conferences to obtain a multidisciplinary review in order to achieve optimal outcomes.
Identifies and escalates quality of care issues through established channels.
Demonstrates negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
Delivers 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.
Assists in encouraging members to actively participate with their provider in healthcare decision-making.
Conducts comprehensive evaluations of referred members’ needs/eligibility using care management tools and recommends an approach to case resolution.
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.
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
Will work closely with the Utilization Management team on transitioning members from the hospital to a lower level of care for more seamless care coordination.
Required Qualifications
- Applicants must reside in Washington DC, Maryland or Northern Virginia, but Maryland residency is preferred (any field work will be conducted in Maryland)
- Ability to travel up to 20% of time
- Minimum 2 years experience in a clinical environment (I.e. clinical call center, hospital setting, health coach, doctors office, social work with a behavioral health focus)
- Demonstrated attention to detail
- Strong communication skills
- Strong technology skills
Preferred Qualifications
-Case management setting experience behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling).
-Bilingual in Spanish
-Experience working with Medicaid population
Education
- Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work) or other healthcare related fields.
Pay Range
The typical pay range for this role is:
$19.52 - $42.91This 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.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.