Case Management Coordinator - Transition of Care Team

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

Fundamental Components

• 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.

• 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.

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

• 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.

• Identifies and escalates quality of care issues through established channels.

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

• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve 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 knowledgeably participate with their provider in healthcare decision-making.

• 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.

Remote Work Expectations

• This a remote role, 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.

Required Qualifications

• 2+ years experience in behavioral health or social services

• Candidate must have the ability to work 8:00 AM - 5:00 PM in assigned market time zone

• 2+ years of experience with Microsoft Office Applications (Word, Excel, Outlook)

• 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

Preferred Qualifications

• Case management and discharge planning experience

• Managed care experience

Education

• Bachelor's Degree or non-licensed master level clinician with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling) or equivalent experience (REQUIRED)

Work from Home Requirements

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.

• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.

• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.

• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).

• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.

• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.

• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).

• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.

• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.

• Future Growth: Openness to learning new skills in the future as the workplace environment evolves