Case Management Specialist

Telephonic Care Manager Specialist

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

As an essential member of our Special Needs Plan (SNP) care team, the telephonic Care Manager Specialist (CMS) plays a key role in coordinating the care of our members, particularly those with social determinants of health (SDoH) needs and stable health conditions. The CMS collaborates closely with the Registered Nurse Care Manager, Care Coordinator, Social Worker, and other interdisciplinary care team participants to support the member in maintaining optimal health. This is achieved by evaluating the members' needs through the completion of the annual Health Risk Assessment Survey, addressing SDoH needs, and closing gaps in preventative and health maintenance care.

Key Responsibilities

• Telephonic Engagement: Dedicate 50-75% of the day to engaging with members and coordinating their care.
• Member Outreach: Utilize all available resources to connect with and engage "hard-to-reach" members.
• Care Planning: Partner with members to develop individualized care plans that encompass goals and interventions to meet their identified needs.
• Documentation: Maintain meticulous documentation of care management activities in the member's electronic health record.
• Collaboration: Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member's stable health condition.
• Resource Connection: Identify and connect members with health plan benefits and community resources.
• Regulatory Compliance: Meet regulatory requirements within specified timelines.
• Consults: With the Care Manager RN within the Care Team for clinical knowledge, medication regimes, and supportive clinical decision making.
• Collaborates and leverages: The Care Manager RN clinical expertise to ensure members' needs are adequately addressed.
• Additional Responsibilities: Support team objectives, enhance operational efficiency, and ensure delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.

Essential Competencies and Functions

• Performance Metrics: Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements.
• Professional Conduct: Conduct oneself with integrity, professionalism, and self-direction.
• Care Management Knowledge: Experience or willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care.
• Community Resources: Familiarity with community resources and services.
• Healthcare Technology: Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
• Collaboration: Maintain strong collaborative and professional relationships with members and colleagues.
• Communication Skills: Communicate effectively, both verbally and in writing.
• Customer Service: Excellent customer service and engagement skills.

Required Qualifications

• 2+ years of experience in a health-related field
• 2+ years of customer service experience
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and ability to effectively utilize these tools within the Case Management Specialist (CMS) role
• Access to a private, dedicated space to conduct work effectively to meet the requirements of the position

Preferred Qualifications

• Experience providing care management for Medicare and/or Medicaid members
• Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health
• Experience conducting health-related assessments and facilitating the care planning processes
• Bilingual skills, especially English-Spanish

Education

• Associate's degree and relevant experience in a health care-related field (REQUIRED)
• Practical Nurse Degree/Certificate with active licensure that meets state requirements OR bachelor's degree in health care or a related field (PREFERRED)

Work from Home Requirements

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $21.10 - $40.90

This 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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

We anticipate the application window for this opening will close on: 09/23/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.