Care Management Coordinator

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Qualified candidates preferably will reside in the Central OKC area/region which includes Oklahoma county.

Responsible for ensuring the functioning of care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). Utilizes critical thinking and judgment to collaborate and inform the care management/ care coordination 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:

• Uses care management tools and information through data review to conduct 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.
• Using a holistic approach consults with clinical care managers, leadership, medical directors and/or other health/behavioral 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.
• Works collaboratively with the members' interdisciplinary care team.
• 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.
• Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access.
• Monitors, evaluates and documents care utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Identifies, refers, and links members to providers and social supports as needed (e.g., scheduling appointments, arranging transportation).
• Educates members about available resources and services such as Oklahoma value-added benefits and assisting the member in accessing those resources and services.
• Facilitates clinical hand offs during transitions of care.

Required Qualifications

• Must reside in Oklahoma
• 2+ years of related professional experience including acting as a care manager, rehabilitation specialist, health specialist, or social services coordinator.
• Must complete the Behavioral Health Case Manager certification training provided through the Department of Mental Health and Substance Abuse Services within 6 month of hire date.
• 2+ years' experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
• Must possess reliable transportation and be willing and able to travel in-state up to 30% of the time. Mileage is reimbursed per our company expense reimbursement policy.
• Willing and able to provide on-call CM coverage for nights and weekends on a rotational schedule as required by the State regulatory agency.

Preferred Qualifications

• Case management and discharge planning experience
• Managed Care experience
• Experience providing care to American Indian/Indigenous American/Native American populations

Education

• Minimum of a Bachelor's degree in social work, psychology, or a related social services field or unlicensed masters prepared behavioral health clinician.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$21.10 - $36.78

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

We anticipate the application window for this opening will close on: 08/19/2025

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