Case Manager

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 colleagues who care deeply, innovate with purpose, and prioritize safety and quality in everything they do.

Position Summary This position is for Virginia Only candidates with up to 70% travel required in Central region Virginia.

Job Responsibilities

• Utilizes critical thinking and judgment to collaborate and inform the case management process to facilitate appropriate healthcare outcomes for members by providing care coordination, support, and education for members using care management tools and resources.
• Uses care management tools and information to evaluate members, conducts comprehensive evaluation of 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 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 needed.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Enhances Medical Appropriateness and Quality of Care by consulting 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 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 healthcare needs.
• Utilizes 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 members to make ongoing independent medical and/or healthy lifestyle choices.
• Helps members actively and knowledgably 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.

Required Qualifications

• 2 years' experience in behavioral health, social services, or a related field equivalent to program focus.
• Must reside in Central Virginia Area.
• Up to 70% travel will be required in Central region.

Preferred Qualifications

• Case management and discharge planning experience preferred.
• Managed Care experience preferred.

Education

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

Anticipated Weekly Hours 40

Time Type Full-time

Pay Range $21.10 - $40.90

Benefits This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.