At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Care Management Coordinators (CMC) drive and support care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating) working with members with behavioral health and physical health conditions. The CMC will be providing care coordination service to a Medicaid population.The CMC utilizes critical thinking and judgment to collaborate and inform the care management/care coordination process in order to facilitate appropriate healthcare outcomes for assigned members. They provide care coordination, support and education for members through the use of care management tools and resources.
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Position Responsibilities:
- Uses care management tools and information to complete a comprehensive evaluation of members and recommends an approach to case resolution by determining member needs in alignment with their benefit plan and available internal and external programs and services.
- Identifies high risk factors and service needs that may impact member outcomes and care planning with appropriate referral to clinical case management or crisis intervention as appropriate.
- Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve an optimum level of health.
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Helps member actively and knowledgably participate with their provider in healthcare decision-making.
- Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access.
- Coordinates and implements assigned care plan activities and monitors care plan progress.
- Using a holistic approach consults with clinical care managers, leadership, medical directors and other physical/behavioral health support staff and providers to overcome barriers to meeting member goals and objectives.
- Presents cases at case conferences/rounds to obtain multidisciplinary review in order to achieve optimal outcomes.
- Works collaboratively with the members' interdisciplinary care team.
- In collaboration with the member and their care team develops and monitors established plans of care to meet the member's goals.
- Identifies and escalates quality of care issues through established channels.
- Monitors, evaluates and documents care utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
- Identifies, refers, and links members to providers and social supports as needed (e.g., scheduling appointments, arranging transportation).
- Educates members about available resources and services such as Florida value-added benefits and assisting the member in accessing those resources and services.
- Facilitates clinical hand offs during transitions of care.
- 2 years of related professional experience includes acting as a care manager, rehabilitation specialist, health specialist, social services coordinator etc.
- Experience working with a diverse population required
- Must reside in the State of Florida
- Experience with autism and the pediatric population
- Managed Care experience preferred
- Bilingual Spanish preferred
- Bachelor's degree in social work, psychology, or a related social services field is required
40Time Type
Full timePay Range
The typical pay range for this role is:$21.10 - $36.78This 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.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.