Case Management Coordinator -Pike/Adam County IL
CVS Pharmacy - Quincy, IL
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Job DescriptionUtilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitateappropriate healthcare outcomes for members by providing care coordination, support and education formembers through the use of care management tools andresources.Evaluation of Members: -Through the use ofcare management tools and information/data review,conducts comprehensive evaluation of referred member'sneeds/eligibility and recommends an approach to caseresolution and/or meeting needs by evaluating member'sbenefit plan and available internal and externalprograms/services. Identifies high risk factors and serviceneeds that may impact member outcomes and careplanning components with appropriate referral to clinicalcase management or crisis intervention as appropriate. -Coordinates and implements assigned care plan activitiesand monitors care plan progress. Enhancement of MedicalAppropriateness and Quality of Care: - Using holisticapproach consults with case managers, supervisors,Medical Directors and/or other health programs toovercome barriers to meeting goals and objectives;presents cases at case conferences to obtainmultidisciplinary review in order to achieve optimaloutcomes. - Identifies and escalates quality of care issuesthrough established channels. -Utilizes negotiation skills tosecure appropriate options and services necessary tomeet the member's benefits and/or healthcare needs. -Utilizes influencing/ motivational interviewing skills toensure maximum member engagement and promotelifestyle/behavior changes to achieve optimum level ofhealth. -Provides coaching, information and support toempower the member to make ongoing independentmedical and/or healthy lifestyle choices. -Helps memberactively and knowledgably participate with their provider inhealthcare decision-making. Monitoring, Evaluation andDocumentation of Care: - Utilizes case management andquality management processes in compliance withregulatory and accreditation guidelines and companypolicies and procedures.Pay RangeThe typical pay range for this role is:Minimum: 19.50Maximum: 38.99Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required QualificationsMinimum 2 years of experience in behavioral health, social services or human services field.- Willing and able to travel up to 50-75% of their time using their own vehicle to meet members face to face in Pike/Adam counties IL and surrounding areas.Preferred Qualifications-Case management and discharge planning experiencepreferred-Managed Care experience preferred-Microsoft Office experience preferredEducationBachelor's degree or non-licensed master level clinicianrequired, with either degree being in behavioral health or human services required. ( Ex - psychology, social work,marriage and family therapy, counseling)Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Created: 2024-09-07