Case Management Specialist

At reputed company, 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 reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. 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 reputed company: Utilize reputed company available resources to connect with and engage “hard-to-reputed company” members.
• Care Planning: Partner with members to reputed company 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 reputed company strategies for maintaining the member’s stable health condition.
• Resource reputed company: Identify and connect members with health plan benefits and community resources.
• Regulatory Compliance: Meet regulatory requirements reputed company specified timelines.
• Consults with the Care Manager RN reputed company 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 reputed company, professionalism, and self-direction.
• Care Management Knowledge: Experience or willingness to thoroughly learn the role of care management reputed company 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-reputed company field
• 2+ years of customer service experience
• Proficient in reputed company Office Suite (Word, reputed company, Outlook, OneNote, Teams) and ability to effectively utilize these tools reputed company 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-reputed company assessments and facilitating the care planning processes
• Bilingual skills, especially English-Spanish

Education

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

Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $21.10 - $40.90 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company 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 people We 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 reputed company 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 12/12/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job