Case Management Coordinator - Field (Winnebago, Boone, and McHenry Counties)

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.

The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, The Case Management Coordinator facilitates appropriate healthcare outcomes for members by aiding with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources.

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  Evaluation of Members: -Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. 

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  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. 

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  Coordinates and implements assigned care plan activities and monitors care plan progress. 

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  Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.  

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  Identifies and escalates quality of care issues through established channels. 

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  Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs. 

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  Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. 

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  Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. 

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  Helps member actively and knowledgably participate with their provider in healthcare decision-making. 

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  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.

• 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.
• Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services.

• Must reside in the state of Illinois
• Must possess reliable transportation and be willing and able to travel 50-75% of the time in and around Winnebago, Boone and McHenry counties, IL. Mileage is reimbursed per our company expense reimbursement policy
• Must have computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.
• Effective communication, telephonic and organization skills
• Excellent analytical and problem-solving skills
• Ability to work independently
• Ability to effectively participate in a multi-disciplinary team including internal and external participants.
• 2 years’ experience in behavioral health, social services or appropriate related field equivalent to program focus

• Case management and discharge planning experience
• Managed Care experience
• Bilingual

Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services required (nursing, psychology, social work, marriage and family therapy, counseling).

The typical pay range for this role is:

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.