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CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca
Care Management Coordinator Central and SE Region
Location
United States
Posted
95 days ago
Salary
$21 - $41 / hour
Seniority
Mid Level
Job Description
Care Management Coordinator Central and SE Region
CVS Health
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. Potential Anticipated Backfill-Remove this before posting. Position Summary This is a full-time field-based telework position, in Ohio. This position requires the ability to travel within the assigned region of Ohio to member homes and other requested member locations, up to 50% or more of the time. Applicants must reside in central or southeastern Ohio. Preferred counties: Franklin, Ashland, Athens, Coshocton, Delaware, Fairfield, Fayette, Gallia, Guernsey, Highland, Hocking, Holmes, Jackson, Knox, Licking, Meigs, Morgan, Morrow, Muskingum, Noble, Perry, Pickaway, Pike, Richland, Ross, Vinton, Washington and Wayne. Monday-Friday 8-5pm with flexibility needed to work later to meet member needs. Business Overview As part of the bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, OhioRISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems. The Care Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management 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: • Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems. • Evaluation of Members: o 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 referral to clinical case management or crisis intervention as appropriate. o Coordinates and implements assigned care plan activities and monitors care plan progress. • Enhancement of Medical Appropriateness and Quality of Care: o Using holistic approach consults with case managers, supervisors, 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. o Works collaboratively with the members' Child and Family Teams. o Identifies and escalates quality of care issues through established channels. o Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs. o Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. o Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. o Helps member actively and knowledgably participate with their provider in healthcare decision-making. o Serves a single point of contact for members and assist members to remediate immediate and acute gaps in care and access. • Monitoring, Evaluation and Documentation of Care: o Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Required Qualifications - 2+ years of experience in behavioral health, social services, or human services - 2+ years of experience with personal computers, keyboard and multi-system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint). - 2+ years of experience in children's mental health, child welfare, developmental disabilities, juvenile justice, or a public sector human services or behavioral health care field, providing community-based services to children and youth, and their family/caregivers. - 2+ years experience in one or more of the following areas of expertise: family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development. - 2+ year of experience with Ohio delivery systems, including local community networks and resources. - Willing and able to travel within the assigned region up to 50% of the time; Some travel to the New Albany office may be required for trainings/meetings: - Reliable transportation required - Mileage is reimbursed per our company expense reimbursement policy - Willing and able to work beyond core business hours of Monday-Friday, 8am-5pm, as needed. - Bachelor’s degree or non-licensed master level clinician required - Must reside in Ohio Preferred Qualifications - Case management and discharge planning experience. - Managed Care experience. - Medicaid experience. Education Bachelor’s degree or non-licensed master level clinician required, with either degree being in behavioral health, human services, health services, or public health preferred. (i.e. psychology, social work, marriage and family therapy, counseling, juvenile justice). 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 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: 03/31/2026 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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Gainwell TechnologiesGainwell Technologies is an award-winning digital health technology company that supports the administration of healthcare and human services programs. In past
Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Summary As a Call Center Representative - Remote Arkansas at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position. Your role in our mission This role falls under the Insurance/Healthcare job family and leverages call center expertise to support insurance and healthcare operations. 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Ability to manage tasks and assignments without detailed direction. • Identifies, prioritizes, and resolves some issues independently, and escalates more complex questions or issues appropriately. • Complies with contract requirements, business unit rules and related legal regulations. What we're looking for • High School Diploma or equivalent; may hold 2-year post-high school Degree; may hold bachelor’s degree. • Prior office or clerical experience preferred with the ability to follow written policies and procedures. • 1-2 years of working experience in Contact (Call) Center; experience with CxOne, Avaya or previous call center software is a plus • Ability to access and retrieve information using a laptop and basic understanding of Microsoft Office products. • Ability to follow procedural guidelines and work on assignments with limited instructions from leadership. 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All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities. We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings. Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.
Job DetailsJob Location: Advocacy Fort Lauderdale Office - Plantation, FL 33317Position Type: Full TimeSalary Range: $18.00 - $18.00 HourlyJob Category: Customer ServiceDo you want to have a fulfilling career with purpose helping military veterans? The VA Intake Specialist will be a direct point of contact for potential new clients. They provide great customer service and have a clear phone presence. They should be proficient in using computers, be able to verify that there are no discrepancies within documents, and excel at both verbal and written communication. The ideal candidate for this position is detail-oriented, professional, and has a genuine desire to meet the needs of others. Work hours are Monday – Friday and can be from 9:00 am to 6:00 pm EST, or from 10:00 am to 7:00 pm EST. This is a remote work from home position Our benefits package includes health, dental, and vision insurance, company paid life insurance and disability insurance, a 401(k) plan with an employer match, paid time off after 90 days of employment, and ten company paid holidays. Essential Functions: · Receive all inbound and outbound calls for potential disability clients · Perform general office clerk duties · Ask a series of questions verbatim for the purpose of compiling data about the client to confirm eligibility · Record information as needed · Respect client confidentiality · Performs other related duties as assigned. QualificationsRequired Skills/Abilities: · Must have 2 years of experience using an auto-dialer system and reading a script verbatim · Experience using computers and performing data-entry functions · Legal experience is a plus · Minimum typing speed of 35 WPM · Ability to type and talk while using a hands free headset · Solid reading, writing, and verbal communication skills · Professional communication skills over the phone and with co-workers and supervisors · Previous telecommuting/remote work experience is a plus · Must be able to multitask and be proficient in the use of today’s technology · Must have a desk, chair and basic essentials to work from home · Must have a quiet work area without noise or distractions · Must have your own/personal high speed internet ** you cannot use Wi-Fi ** · Reliable and dependable attendance. Education and Experience: · This job requires a minimum of a high school diploma or G.E.D and two years of previous call center experience. Associate degree is preferred. · Experience using computers and performing data-entry functions. Physical Requirements: · Prolonged periods of sitting at a desk, talking on a telephone and working on a computer. Remote Work from Home Requirements: · Not all positions are remote; some require that the employee work in the office. · Must have a desk, chair and basic essentials to work from home. · Must have a quiet work area without noise or distractions. · Must have personal high speed internet service (Wi-Fi is not acceptable). Our minimum internet speed requirement is 100 download & 20 upload MBPS speed. · Must be logged onto your work computer and able to answer calls during your normal work hours. · Remote workers must be based in the United States and must reside in one of the following states: FL, GA, IL, IN, MI, NC, NJ, NV, NY, PA, SC, TX or WV. Must be able to work EST hours provided above.
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PART TIME Patient Access & Care Team Rep (Remote)
American Addiction CentersLeading nationwide provider of substance use treatment offering a full continuum of care. #FreedomFromAddiction
Department: 12700 Enterprise Corporate - Patient Access & Care Team: IL/WI Operations Status: Part time Benefits Eligible: Yes Hours Per Week: 20 Schedule Details/Additional Information: PART‑TIME SCHEDULE OPTIONS (AS AVAILABLE): Option 1 – Flexible First Shift (20 hours/week) • First shift with flexible hours • Availability on Mondays and Tuesdays is required Option 2 – Structured First Shift (20 hours/week) • 8:00 AM – 1:00 PM CST • Monday, Tuesday, Wednesday, and Saturday Option 3 – Second Shift (20 hours/week) • Start time options: 2:30 PM, 3:00 PM, 3:30 PM, or 4:00 PM CST • Workdays: Monday, Tuesday, Saturday, plus one additional weekday of your choice Option 4 – Weekend‑Focused Schedule (24 hours/week) • 8:00 AM – 4:30 PM CST • Saturday, Sunday, and Monday Option 5 – Flexible Hours, Multiple Shift Lengths (20 or 24 hours/week) • Work between 7:00 AM – 6:00 PM CST • Mondays and Tuesdays required • Choose shifts of 4, 8, 10, or 12 hours Schedules are limited and assigned based on availability at the time of offer. Pay Range $21.85 - $32.80 MAJOR RESPONSIBILITIES: Uses protocols, facility/provider information, and established policies and procedures to seamlessly link the patient experience between the Patient Access & Care Team (PACT) and the practice site. Uses resources and critical thinking skills to assist inbound callers. Makes outbound calls when required or when follow up is deemed necessary. Has the ability to recognize complex non-clinical problems and questions and escalates for resolution when needed. Responsibilities include scheduling patient appointments and coordinating cancellations, reschedules, and additions to schedules. Obtains demographic and insurance information, verifies insurance coverage, and may collect co-pays, deductibles, and previous balances. Ensures insurance and patient information obtained is complete and accurate, updating information if necessary, applying acquired knowledge of government and third-party payer requirements. Updates financial responsibility and other data when changes or additions occur and communicates to patients as appropriate. Provides referrals to physicians/providers. Completes all essential forms, obtains necessary information, such as patient demographic and insurance information. Verifies and updates the medical record with customer information. Identifies emergent calls based on information provided by caller and department guidelines. Follows the process for immediate transfer to Registered Nurse for triaging or appropriate more experienced staff for resolution. Responsible for competency in and adherence to guidelines for emergency situations and critical call handling. Determines the level of care needed by patients calling the call center which results in routing patients for triage, scheduling, rescheduling, and canceling appointments, submitting medication refill requests for evaluation, and paging providers and facilities as appropriate. Provides customer service per established departmental standards as measured by patients on post call survey. Asks clarifying questions, presents options or solutions, and understands the level of complexity of the call, escalating only those situations necessary for resolution. Assists with organizational marketing efforts by providing associated information and referral to customer, while maintaining appropriate records for documentation. Conducts regular reporting and updating of the provider and marketing databases. Performs additional duties based on department needs such as faxing, updating medical records, logs, and reports, managing files/databases, assisting with entering, gathering, organizing, and compiling data for reports. Maintains knowledge and efficient utilization of all information systems utilized by the department. Licensure, Registration and/or Certification Required: None Required. Education Required: High School Graduate. Experience Required: Experience in healthcare preferred. Experience in a call center preferred, or other applicable customer service-related area. Knowledge, Skills & Abilities Required: Knowledge of customer service and ability to work with a variety of patients and patient situations. Ability to follow workflows while operating in a structured environment. Basic knowledge of medical terminology is helpful, but not required. Basic understanding of computers and desktop software packages. Ability to work in a fast paced environment, handling a variety of customer/patient needs. Basic multitasking and problem solving skills, as well as organization and prioritization skills. Ability to use/manage a multiple-line telephone system. Demonstrated ability for analysis, logical thinking, accuracy and concern for detail. Strong verbal communication skills and ability to interact with a diverse customer population. Ability to provide excellent customer service and follow up. Ability to converse with customers/patients while researching and documenting the call on multiple systems. Ability to work with a variety of customers and actively listen to successfully determine the customer's needs. Ability to resolve customer issues. Ability to work a variety of hours based on departmental business needs. Physical Requirements and Working Conditions: Must have functional vision, touch, speech, and hearing. Required to sit most of the workday. Operates all equipment necessary to perform the job. Exposed to normal office environment and/or remote work environments. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation - Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training - Premium pay such as shift, on call, and more based on a teammate's job - Incentive pay for select positions - Opportunity for annual increases based on performance Benefits and more - Paid Time Off programs - Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability - Flexible Spending Accounts for eligible health care and dependent care expenses - Family benefits such as adoption assistance and paid parental leave - Defined contribution retirement plans with employer match and other financial wellness programs - Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.


