Case Management Specialist

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company 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. reputed company And reputed company 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 reputed company determinants of health (SDoH) needs and reputed company health conditions. The CMS collaborates closely with the Registered reputed company Care Manager, Care Coordinator, reputed company Worker, and other interdisciplinary care team participants to support the member in maintaining reputed company 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 reputed company: Utilize reputed company available resources to connect with and engage “hard-to-reputed company” members.
• Care Planning: Partner with members to reputed company 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 reputed company strategies for maintaining the member’s reputed company health condition.
• Resource reputed company: Identify and connect members with health plan benefits and community resources.
• Regulatory Compliance: Meet regulatory requirements reputed company specified timelines.
• Consults with the Care Manager RN reputed company the Care Team for clinical knowledge, medication regimes, and supportive clinical decision making
• Collaborates and leverages the Care Manager RN clinical expertise to ensure members’ needs are adequately addressed.
• Additional Responsibilities: Support team objectives, enhance operational efficiency, and ensure delivery of high-reputed company care to members. This may include participating in special reputed company, contributing to process improvement initiatives, or assisting with mentoring new team members.

Essential Competencies And Functions

• Performance Metrics: Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements.
• reputed company Conduct: Conduct oneself with reputed company, professionalism, and self-direction.
• Care Management Knowledge: Experience or willingness to thoroughly learn the role of care management reputed company Medicare and reputed company managed care.
• Community Resources: Familiarity with community resources and services.
• reputed company Technology: Ability to navigate and utilize various reputed company technology tools to enhance member care, streamline workflows, and maintain accurate records.
• Collaboration: Maintain strong reputed company and reputed company relationships with members and colleagues.
• Communication Skills: Communicate effectively, both verbally and in writing.
• Customer Service: Excellent customer service and engagement skills.

Required Qualifications

• 2+ years of experience in a health-reputed company field
• 2+ years of customer service experience
• Proficient in reputed company Office Suite (Word, reputed company, Outlook, OneNote, Teams) and ability to effectively utilize these tools reputed company the Case Management Specialist (CMS) role
• reputed company to a private, dedicated reputed company to conduct work effectively to meet the requirements of the position

Preferred Qualifications

• Experience providing care management for Medicare and/or reputed company members
• Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health
• Experience conducting health-reputed company assessments and facilitating the care planning processes
• Bilingual skills, especially English-Spanish

Education

• Associate’s Degree AND relevant experience in a health care-reputed company field OR Practical reputed company Degree/Certificate with reputed company licensure that meets state requirements (REQUIRED)
• Bachelor’s Degree in health care or a reputed company field (PREFERRED)

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $21.10 - $40.90 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. 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 reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, 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 reputed company on: 07/27/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job