Title Case Management Coordinator
Position Summary This is a remote position with 50-75% of travel. Schedule is Monday-Friday, standard business hours 8:00am-5:00pm. Candidates must reside in and be willing and able to travel to the following cities: Tampa, Brandon, Riverview, Sun City, Valrico, Gibsonton, Apollo Beach & Ruskin.
We are seeking self-motivated, energetic, detail oriented, highly organized, tech-savvy Case Management Coordinator to join our Case Management team. This opportunity offers a competitive salary and full benefits. Our organization promotes autonomy through a Monday-Friday working schedule, paid holidays, and flexibility as you coordinate the care of your members.
Case Management Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Case Management Coordinator will effectively manage a caseload that includes supportive and medically complex members. 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. Case Management Coordinators will determine appropriate services and supports due to member’s health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports.
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.
- Conducts comprehensive evaluation of Members using care management tools and information/data review
- Coordinates and implements assigned care plan activities and monitors care plan progress
- Conducts 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.
Required Qualifications - 2+ years case management experience required.
- 2+ years experience in behavioral health, social services, psychiatric, and/or mental health required.
COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
Preferred Qualifications - Bilingual Spanish/English preferred.
- Managed Care experience preferred.
- Long Term Care experience preferred.
- Discharge planning experience preferred.
- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.
- Effective communication skills, both verbal and written.
Education - Bachelor's degree in social work, humans services, psychology, sociology, mental health or gerontology required.
- Master's degree in social work, humans services, psychology, sociology, mental health or gerontology preferred.
Business Overview Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
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.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Req ID 2063926BR
Clinical Licensure Required N/A
Job Category Aetna, Behavioral Health
Business Area Aetna
Job Type (Expected Hours Category) Full Time
Location - State/City FL - Apollo Beach, FL - Brandon, FL - Riverview, FL - Tampa, FL - Valrico
Location code OF124
Street Address 7930 Woodland Center Blvd Ste 500
City Tampa
State FL
Zip Code 33614
Country United States
FLSA Non Exempt
Requisition Template Professional
Sourcing Requisition No
No. of Positions 1