Available shift: M-F 11:30am-8:00pm ET

• Collects data from designated administrative sources and reviews findings in order to identify potential enrollees for clinical specialty programs.
• Provides outreach to members to educate them about available specialty programs and to solicit their participation.
• Educates members about available web-based resources.
• Under direction of clinical management staff and supported by care associates, conducts case management related research and coordinates both internal and external resources, assisting members with claim and benefit issue resolution, referrals to EAP, referrals to legal and financial services and referrals to community support services.
• Serves as primary behavioral health point of contact for member.
• Supports the development and implementation of behavioral health treatment plans, functioning as an integral member of the care management team.
• Participates in designated team meetings and case rounds with other clinical and medical staff.
• Adheres to compliance and Patient Management policies and regulatory requirements.
• Maintains accurate and complete documentation of required information meeting risk management, regulatory and accreditation requirements.
• Participates in designated clinical quality management initiatives.
• Exhibits behaviors outlined in Employee Competencies.

Pay Range
The typical pay range for this role is:
Minimum: 19.50
Maximum: 40.10

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

• At least 1 year of customer service experience.
• Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.
• Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps in order to ensure sufficient speed to adequately perform work duties. Some candidates may be eligible for partial reimbursement of the cost of residential broadband service

Preferred Qualifications

• Call center experience preferred
• Experience in behavioral health treatment settings preferred
• Effective communication, telephonic and organization skills
• Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
• Familiarity with basic medical terminology

Education

• Health Insurance preferred but not required
• Microsoft Office Suite

Education

• High School Diploma, G.E.D. or equivalent experience

Business Overview
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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.