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.

Job Summary

The Care Manager is a member of the Care Team. The Care Manager is responsible for the care management of members that are enrolled in the Dual Special Needs Plan and have limited health conditions. These members are usually stratified as low risk. The Care Manager will work in conjunction with the Nurse Care Manager, Care Coordinator, Transition of Care (TOC) Coach, and other members of the Care Team to improve the member’s health outcomes, address social determinants of health and connect members with community-based organizations. The Care Manager will assess member’s needs as well as gaps in care, communicate with the member’s Primary Care Provider (PCP), maintain updated individualized care plans and participate in Interdisciplinary team meetings. Care Managers will be able to identify members whose needs require clinician involvement and transition members appropriately.

Job Responsibilities

• Responsible for interacting with low stratification members via phone calls, coordinating care, completing, reviewing, and updating assessments and care plans that address problems, goals and interventions.
• Based on assessments and claims data creates a care plan for members to follow
• Participate as a member of the Care Team during Interdisciplinary Team meetings to discuss the member’s health care needs, barriers to care and explore better outcomes for the member.
• Identify and link members with health plan benefits and community resources Perform administrative work to maintain skills needed for job duties

Essential Qualifications and Functions

• Regular and reliable attendance
• Familiar with community resources & services
• Strong organizational skills
• Works independently
• Maintains professional relationships with the members we serve as well as colleagues
• Communicates effectively and professionally verbally and in writing
• Proficient with computer systems
• Knowledgeable in Microsoft Office Software
• Excellent customer service skills
• Has a dedicated homework space

Required Qualifications

• 3+ years experience in health-related field
• 2+ years of customer service experience
• 2+ years of experience with claims

Preferred Qualifications

• CRC, CDMS, CRRN, COHN, or CCM certification
• Medicare and Medicaid experience
• Managed care experience
• Experience working with geriatric special needs, behavioral health and disable population
• Effective computer skills including navigating multiple systems and keyboarding
• Knowledge of assessment, screenings, and care planning
• Bilingual (English/Spanish; English/Creole)

Education

• Bachelor’s Degree in a healthcare related field (social work, case management, public health, behavioral health) or equivalent work experience (REQUIRED)
• Master's Degree (PREFERRED)

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This 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 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 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.