Case Management Coordinator - Field (West Cook County, IL)

Position Summary The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits, and educating members through the use of care management tools and resources. Evaluation of Members Conducts comprehensive evaluation of members’ needs and eligibility using care management tools and data review, and recommends an approach to case resolution and/or meeting needs by evaluating members’ benefit plans and available internal and external programs/services. Identifies high‑risk factors and service needs that may impact member outcomes and behavior with appropriate referral to clinical case management or crisis intervention as appropriate. Coordinates and implements assigned care plan activities and monitors care plan progress. Enhancement of Medical Appropriateness and Quality of Care Consults with case managers, supervisors, Medical Directors, and other health programs to overcome barriers to meeting goals and objectives, and presents cases at case conferences for multidisciplinary review 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. Uses influencing/motivational interviewing to ensure maximum member engagement and promote lifestyle/behavior changes. Provides coaching, information, and support to empower members to make independent medical and healthy lifestyle choices. Engages with colleagues in ongoing team meetings and offers peer mentoring/training. Helps members actively and knowledgeably participate with their providers 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. Remote Work Expectations This is a field/remote role; candidates must have a dedicated workspace free of interruptions. Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. Required Qualifications Candidate must reside in Oak Park, Cicero, Elmhurst, Orland Park or West Side of Chicago, IL. Must be willing and able to travel 50‑75% of the time (reliable transportation required; mileage reimbursed per company policy). 2+ years experience in behavioral health, social services, or an equivalent related field. 2+ years of electronic documentation experience and familiarity with Microsoft Office applications. Preferred Qualifications Case management and discharge planning experience. Managed care experience. Education Bachelor’s Degree or a non‑licensed master’s level clinician degree in behavioral health or human services (e.g., psychology, social work, marriage and family therapy, counseling) is required. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $21.10 – $44.99. This 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 experience, education, geography and other 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. Benefits Comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. Benefits include medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources based on eligibility. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. #J-18808-Ljbffr CVS Health