Case Management Specialist

Job Purpose and Summary 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. Consultation with Care Manager RN: Collaborate with the RN for clinical knowledge, medication regimes, and supportive clinical decision‑making. Additional Responsibilities: Support team objectives, enhance operational efficiency, and ensure delivery of high‑quality care to members; may include participation in special projects, process improvement initiatives, or mentoring new team members. Essential Competencies and Functions Performance Metrics: 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. Educational: Associate’s Degree and relevant experience in a health care‑related field OR Practical Nurse Degree/Certificate with active licensure that meets state requirements (REQUIRED). Preferred: Bachelor’s Degree in health care or a related field. 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. Anticipated Weekly Hours 40 hours per week. Full time. Pay Range The typical pay range for this role is $21.10 – $40.90 per hour. 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 Eligible for a comprehensive benefits package that includes medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources, based on eligibility. EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. Application Window Application window closes on 06/25/2026. #J-18808-Ljbffr