Case Management Specialist

$21.10 - $40.90 / hour

Job Purpose and Summary

As an essential member of our Special Needs Plan (SNP) care team, the telephonic Care Manager Specialist (CMS) plays a key role in coordinating the care of our members, particularly those with social determinants of health (SDoH) needs and stable health conditions. The CMS collaborates closely with the Registered Nurse Care Manager, Care Coordinator, Social Worker, and other interdisciplinary care team participants to support the member in maintaining optimal health. This is achieved by evaluating the members’ needs through the completion of the annual Health Risk Assessment Survey, addressing SDoH needs, and closing gaps in preventative and health maintenance care.

Key Responsibilities

Telephonic Engagement: Dedicate 50-75% of the day to engaging with members and coordinating their care.
Member Outreach: Utilize all available resources to connect with and engage “hard-to-reach” members.
Care Planning: Partner with members to develop individualized care plans that encompass goals and interventions to meet their identified needs.
Documentation: Maintain meticulous documentation of care management activities in the member’s electronic health record.
Collaboration: Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
Resource Connection: Identify and connect members with health plan benefits and community resources.
Regulatory Compliance: Meet regulatory requirements within specified timelines.
Consults with the Care Manager RN within the Care Team for clinical knowledge, medication regimes, and supportive clinical decision making
Collaborates and leverages the Care Manager RN clinical expertise to ensure members’ needs are adequately addressed.
Additional Responsibilities: Support team objectives, enhance operational efficiency, and ensure delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.

Essential Competencies and Functions

Performance Metrics: Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements.
Professional Conduct: Conduct oneself with integrity, professionalism, and self-direction.
Care Management Knowledge: Experience or willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care.
Community Resources: Familiarity with community resources and services.
Healthcare Technology: Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
Collaboration: Maintain strong collaborative and professional relationships with members and colleagues.
Communication Skills: Communicate effectively, both verbally and in writing.
Customer Service: Excellent customer service and engagement skills.

Required Qualifications

2+ years of experience in a health-related field
2+ years of customer service experience
Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams) and ability to effectively utilize these tools within the Case Management Specialist (CMS) role
Access to a private, dedicated space to conduct work effectively to meet the requirements of the position

Preferred Qualifications

Experience providing care management for Medicare and/or Medicaid members
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health
Experience conducting health-related assessments and facilitating the care planning processes
Bilingual skills, especially English-Spanish

Education

Associate’s Degree AND relevant experience in a health care-related field OR Practical Nurse Degree/Certificate with active licensure that meets state requirements (REQUIRED)
Bachelor’s Degree in health care or a related field (PREFERRED)

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$21.10 - $40.90

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

We anticipate the application window for this opening will close on: 03/24/2026

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

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