CVS Health Case Management Coordinator in Dallas, Texas
Schedule is Monday-Friday, standard business hours, 8:00am-5:00pm CST.This is a fully remote work from home position that will require local travel, 50-75% , for home visits and possible community visits once COVID restrictions are lifted. The territory includes Dallas & Collin County. The position requires advanced clinical judgment and critical thinking skills in order to facilitate appropriate physical, behavioral health, psychosocial wrap around services. The care manager will be responsible for, care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner. Strong assessment, writing and communication skills are required. Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members. Health service strategies, policies, and programs are comprised of utilization management, quality management, network management, clinical coverage and policies. The Case Manager is responsible for:- Conducting face to face visits in the members home utilizing comprehensive assessment tools for members enrolled in Long-Term Services and Support programs.- Coordinating and collaborating care with the member/authorized representative, PCP, and any other care team participants. - Scheduling and attending interdisciplinary meetings and advocating on the members behalf to ensure proper and safe discharge with appropriate services in place. - Working with the member and care team to develop a care plan and authorizing services in a cost-effective manner within the LTSS benefit. - Documenting accurately and timely in the member’s electronic health record. - Using critical thinking skills and the ability to problem solve. - Mentoring new hires once a level of proficiency has been attained in their role. Assessment of Members: -Through the use of care management tools and information/data review, the Case Manager 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 members outcome and care planning components with appropriate referrals. - Coordinates and implements assigned care plan activities and monitors care plan progress. Enhancement of Medical Appropriateness and Quality of Care; - Uses a holistic approach to overcome barriers to meet 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 processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
- 2+ years of experience in behavioral health or social services required.
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
- Managed care experience preferred.- Case management and discharge planning experience preferred.- Experience working with behavioral health members preferred.
Bachelor's of Science degree or non-licensed Master level clinician required, with either degree being in behavioral health or specific human services (psychology, social work, counseling.)
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.