Remote Case Management Coordinator/Transition of Care

CVS Health

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Job ID: 2511325BR
Category: Medicaid
Remote: Fully Remote

Job Description
Schedule is standard business hours, 8:00am-5:00pm
EST. No nights, no weekend and no holidays. Qualified candidates must be located in DC, Maryland, or Northern Virginia.

Utilizes critical thinking and judgment to collaborate and
inform the case management process, in order to facilitate
appropriate healthcare outcomes for members by providing
care coordination, support and education for members
through the use of care management tools and resources.
Fundamental Components & Physical Requirements
include but are not limited to (* denotes essential functions)
• 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
– 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
– 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
-Provides coaching, information and support to empower
the member to make ongoing independent medical and/or
healthy lifestyle choices.
-Helps member actively and knowledgably participate with
their provider in healthcare decision-making.
• Monitoring, Evaluation and Documentation of Care: 1
– Utilizes case management and quality management
processes in compliance with regulatory and accreditation
guidelines and company policies and procedures.
-Develops a proactive course of action to address issues
presented to enhance the short and long-term outcomes
as well as opportunities to enhance a member’s overall
wellness through integration. Will work closely with the Utilization Management team on transitioning members from the hospital to a lower level of care for more seamless care coordination.

Pay Range
The typical pay range for this role is:
Minimum: 19.50
Maximum: 40.10

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit

Required Qualifications
Minimum 2 years experience in a clinical environment

Preferred Qualifications
-Case management setting experience behavioral health
or human services preferred (psychology, social work,
marriage and family therapy, counseling).
-Discharge planning experience
-Strong communication skills
-Strong technology skills
-Bilingual in Spanish is a plus

Bachelor’s degree or non-licensed master level clinician
required, with either degree being in behavioral health or
human services preferred (psychology, social work) or other healthcare related fields.

Business Overview
Bring your heart to CVS Health Every 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. 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.