Case Management Coordinator - Field (Intensive)

Job DescriptionThis is a remote position with expected travel of up to 80-90%. The schedule is Monday-Friday, 8:00am-5:00pm CST. Flexibility to work beyond core business hours may be required as we are serving the needs of children and families that may require working after school, after work, etc.This position requires routine regional in-state travel; use of personal vehicle is required. Qualified candidates must have valid KY driver's license, proof of vehicle insurance, and reliable transportation. Travel to the Louisville office is also anticipated for meetings and training. This position is assigned to the Two Rivers region. Qualified candidates must reside in one of the following counties: Must reside in Union, Henderson, Webster, Daviess, McLean, Hancock, Ohio, Butler, Logan, Simpson, Warren, Edmonson, Hart, Allen, Barren, Metcalfe, or Monroe county.The Intensive Care Management Coordinator (CMC) is a field based position. This position utilizes critical thinking and professional judgment to collaborate and support the case management process, in order to facilitate improved healthcare outcomes for members with intensive physical and/or behavioral care needs by providing advocacy, coordination, collaboration, support and education through the use of care management tools and resources. Evaluation of Members: - Through the use of care management tools and information/data review, conducts comprehensive assessments of member's needs/eligibility.- Integrates all biopsychosocial information and recommends a holistic approach to supporting the member comprehensive care needs by evaluating and coordinating internal and external programs/services that are available within the member's benefit plan. - Identifies and proactively addresses high risk factors and service needs that may impact member outcomes through care planning interventions.- Coordinates and implements assigned care plan activities and monitors care plan progress. - Provides modifications to care plan to reflect changing needs. - Provide crisis support and stabilization as needed. Enhancement of Medical Appropriateness and Quality of Care: - 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 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 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- 1+ year(s) of experience and detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the Kentucky SKY populations, is required.- 2+ years case management experience required.- 2+ years experience in behavioral health, social services or human services field required. - 1+ year(s) computer experience and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications- Discharge planning experience preferred.- Managed Care experience preferred.- Experience in the delivery of Behavior Health Services and knowledge of best practice treatment delivery systems for intensive member care needs preferred.Education- Bachelor's degree required with either degree being in behavioral health or a human services field of study; Master's degree preferred with either degree being in behavioral health or a relevant human services field of study.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: 2025-06-14