Care Management Specialist
Cvshealth
FL - Work from home; Work At Home-Ohio Posted Discovered via the company's careers siteMatch locked
Full time2+ years exp
About the role
We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.
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
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Telephonic Engagement
Dedicate 50-75% of the day to engaging with members and coordinating their care.
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Member Outreach
Utilize all available resources to connect with and engage "hard-to-reach" members.
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Care Planning
Partner with members to develop individualized care plans that encompass goals and interventions to meet their identified needs.
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Documentation
Maintain meticulous documentation of care management activities in the member's electronic health record.
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Collaboration
Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member's stable health condition.
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Resource Connection
Identify and connect members with health plan benefits and community resources.
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Regulatory Compliance
Meet regulatory requirements within specified timelines.
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Consults
with the Care Manager RN within the Care Team for clinical knowledge, medication regimes, and supportive clinical decision making
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Collaborates and leverages
the Care Manager RN clinical expertise to ensure members' needs are adequately addressed.
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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
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Performance Metrics
Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements.
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Professional Conduct
Conduct oneself with integrity, professionalism, and self-direction.
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Care Management Knowledge
Experience or willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care.
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Community Resources
Familiarity with community resources and services.
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Healthcare Technology
Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
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Collaboration
Maintain strong collaborative and professional relationships with members and colleagues.
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Communication Skills
Communicate effectively, both verbally and in writing.
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Customer Service
Excellent customer service and engagement skills.
Work Expectations
- Access to a private, dedicated space to conduct work effectively to meet the requirements of the position
- Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted
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 Care Manager Specialist
About the role
role
- Access to a private, dedicated space to conduct work effectively to meet the requirements of the position
- Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted
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 with 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
40
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments .
We anticipate the application window for this opening will close on: 10/12/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Not included in the source posting: about the role.
Skills
excel
Who can apply
The employer didn't state any visa, work authorization, citizenship or clearance requirements in this posting. Confirm with the employer before applying.
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