Case Management Coordinator – Field
| Company | CVS Health |
|---|---|
| Location | Litchfield, IL, USA, Springfield, IL, USA |
| Salary | $21.1 – $44.99 |
| Type | Full-Time |
| Degrees | Bachelor’s, Master’s |
| Experience Level | Junior, Mid Level |
Requirements
- Candidate must reside in or near Macoupin or Montgomery County IL (Applicable Zip Codes: 62056, 62615, 62690, 62626, 62088 (Litchfield, Carlinville, Virden, Staunton, Auburn) – within 30-mile radius of these zip codes
- Must possess reliable transportation and be willing and able to travel up to 50-75% of the time to meet with members face to face in Macoupin or Montgomery IL County, or surrounding areas. Mileage is reimbursed per our company expense reimbursement policy.
- Minimum of 2 years of experience in behavioral health or social services field
- Bachelor’s Degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred
Responsibilities
- 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.
- Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
- Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
- Reviews prior claims to address potential impact on current case management and eligibility.
- Assessments include the member’s level of work capacity and related restrictions/limitations.
- Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
- Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
- Utilizes case management processes in compliance with regulatory and company policies and procedures.
- Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
Preferred Qualifications
- Long-Term Care experience
- Case management and discharge planning experience
- Managed care experience
- Microsoft Office (Excel) experience