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.

Position Summary

Utilizes skills to coordinate, document and communicate all aspects of the utilization/benefit management program.

-Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for members by providing care coordination, support and education for members 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 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 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 knowledgably 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.

Required Qualifications

- Must reside in Northern Virginia area; specifically Fairfax, Arlington, Alexandria, Fredericksburg, Rappahannock, Manassas Park, Culpeper County

Prince William, Spotsylvania, Falls Church, Stafford, Winchester, Frederick, Loudon, Clarke, Warren, Madison, or Fauquier county

- Ability to travel up to 50% if the time (mileage reimbursement)
- 2+ years of case management experience working with people who have been designated as having a serious mental illness (SMI) and working with people who are elderly or have a physical disability.

Preferred Qualifications

- Computer proficient with Microsoft Outlook/Word and Windows

- Experience collaborating with medical professionals

- Critical areas to succeed - organization, collaboration and time management

Education

- Candidates must have earned a 4-year bachelor’s degree in Human Services or related fields

Human Services and Related Fields Approved Degrees

· Art Therapy

· Behavioral Sciences

· Child Development

· Child and Family Studies/Services

· Cognitive Sciences

· Community Mental Health

· Counseling (MH, Vocational, Pastoral, etc.)

· Counselor Education · Early Childhood Development

· Education (with a focus in psychology and/or special education)

· Educational Psychology

· Family Development/Relations

· Health and Human Services

· Human Development

· Human Services

· Marriage and Family Therapy

· Nursing

· Pharmacy

· Psychiatric Rehabilitation

· Psychology

· Rehabilitation Counseling

· Social Work

· Sociology

· Special Education

· Speech Therapy

· Therapeutic Recreation

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. 
 
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 jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 09/02/2024

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