Telephonic Care Coach (Maternal-Child Health)

Become a part of our caring community The Telephonic Quality Outreach Professional supports the EPSDT program requirements in a telephonic outreach environment by evaluating member needs and helping families achieve or maintain an optimal state of wellness. The Telephonic Outreach Care Coach Professional 1 performs basic administrative/clerical/operational/customer support/computational tasks. Typically work on straightforward moderate complexity assignments that are routine and structured in nature. The Telephonic Quality Outreach Professional employs a variety of strategies and techniques to coordinate services and resources that facilitate HEDIS gap closure and improve pediatric health outcomes. The supervisor limits decisions to defined parameters around work expectations, quality standards, priorities and timing, and supervises closely and/or works within established policies/practices and guidelines with minimal opportunity for deviation. Position Responsibilities: Telephonic outreach to close HEDIS gaps for Medicaid pediatric population Assist members in addressing barriers to care, including scheduling challenges and transportation needs, to support access to primary care and overall well-being Collaborate with EPSDT Senior Quality Improvement Professional and Coordinator related to strategic outreach to maximize HEDIS outcomes Collaborate with other departments Provide vaccine awareness and education following Bright Futures and EPSDT preventive health guidelines Empower member independence through education and outreach that promote ongoing self-sufficiency in managing preventive and primary care needs Other responsibilities as assigned Use your skills to make an impact Required Qualifications Unrestricted Licensed Practical Nurse (LPN) in

Become a part of our caring community The Transition Coordinator (Care Coach 2) evaluates member's needs and requirements. This evaluation aims to achieve and/or maintain an optimal wellness state. The Coordinator does this by guiding members/families toward resources and facilitating interaction with them. These resources are appropriate for the care and wellbeing of members. The Care Coach 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Position Responsibilities: Support the ongoing member transitions in and out of the Indiana Medicaid programs, the Contractor's enrollment, and among care settings. Complete transitions and assists with the planning and preparation for them, and the follow-up care after. Works with the Member Advocate Coordinator and other member-focused departments of the plan. This collaboration ensures continuity and coordination of care and member and provider communication through the initial transition, ongoing benefit plan, and MCE transfers. Ensure the transfer and receipt of all outstanding prior authorization decisions, utilization management data, and clinical information such as prevention and wellness programs(s), care management and complex case management notes. Help with transitions from the custodial setting to the home and community-based setting. We ask that you have telephonic and in-person meetings within an assigned region. The purpose of these meetings is to work with various stakeholders, including long-term care members, hospital/rehab staff discharge planners, family members/POA's, PCP's, and other healthcare professionals. The ultimate goal is to prevent custodial placements whenever possible. Assess and evaluate member's needs to establish a member specific car

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 Telephonic Engagement: Dedicate 50-75% of the day to engaging with members and coordinating their care. Member Outreach: Utilize all available resources to connect with and engage “hard-to-reach” members. Care Planning: Partner with members to develop individualized care plans that encompass goals and interventions to meet their identified needs. Documentation: Maintain meticulous documentation of care management activities in the member’s electronic health record. Collaboration: Work with the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable h

Become a part of our caring community The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Care Manager, Telephonic Behavioral Health 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Reports to the Regional CM Manager. Use your skills to make an impact Required Qualifications Must have an active, unrestricted SC Licensed Masters Social Worker (LMSW), Licensed Professional Counselor (LPC) OR an active, unrestricted compact Registered Nurse (RN) license . 2 or more years of experience working as a behavior

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. ••work from Home- Candidate may reside in Texas or Arizona•• At CVS Health, we believe we can change the world by improving patient lives, one call at a time. Our Telephonic Registered Nurses (RN) have patient contact in the uniqueness of a telephonic practice setting, where they are impacting lives across the country. You will continue to experience the reasons you became a nurse without having to be in a bedside patient care environment. Working from home, you will be part of a specialized team on the cutting edge of patient care. Working collaboratively with health care professionals, you will provide a meaningful patient experience, while using your critical thinking skills to develop, implement, and evaluate comprehensive plans of care for multiple disease state patients. As a Telephonic Registered Nurse, you will a profound effect on the lives of the patients and caregivers via each outbound call, providing education and support for their new medication. Along with the Compliance and Persistency team, you are the continuity of care supporting defined patient populations through the use of our state-of-the-art telecommunications nursing outreach programs. To be successful in this Registered Nurse position, you must have excellent written and verbal customer service skills, as well as advanced computer skills in order to interact with patients. Our Registered Nurses redefine the way

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. Position Summary: The Complex Nurse Case Manager is responsible for assessing members through regular and consistent in person or telephonic contact to assess, plan, implement and coordinate all case management activities with members to evaluate the medical and psychosocial needs of the member to facilitate and support the member’s improved health. The Case Manager develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness. Services strategies policies and programs are comprised of network management and clinical coverage policies. This is a field-based position that requires routine regional in-state travel 80-90% of the time; use of personal vehicle is required. Qualified candidates must have valid KY driver's license, proof of vehicle insurance, and reliable transportation. Travel to the Louisville office is also anticipated for meetings and training. This position is assigned to the Two Rivers Region. Qualified candidates must reside in one of the counties within Two Rivers (Union, Webster, Henderson, Daviess, Hancock, McLean, Ohio, Butler, Edmonson, Hart, Warren, Logan, Simpson, Allen, Monroe, Metcalfe, Barren). Evaluation of Members: Through the use of clinical assessment tools and evaluating information/data review, conducts a comprehensi