Care Management Coordinator (Maricopa County, Arizona)

Aetna Medicaid Administrators

54d • $21 - $41 • Hybrid

About The Position

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 The Case Management Coordinator is a work-at-home position, working with contracted providers in Phoenix, Arizona. Please note that 25% of the work week will be spent at provider offices, with 75% of the work week spent at home. The Mercy Care RBHA ( Regional Behavioral Health Authority ) 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. Care Management Coordinators utilize knowledge of program requirements, network, and community resources to facilitate appropriate physical and behavioral healthcare and social services for members through collaboration with internal and external providers. The Mercy Care RBHA Care Management Coordinator supports integrated care for the members, which centers on targeting social determinants of health concerns.

Requirements

• 2+ years of experience in behavioral health.
• Must reside in Maricopa County, Arizona.
• Ability travel to providers' offices up to 25% of the time within Phoenix, Arizona.
• Bachelor's degree.

Nice To Haves

• Case management and discharge planning experience.
• Managed Care experience.
• Non-licensed Master's level clinician.

Responsibilities

• Evaluation of Members 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, determined 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 referrals.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Enhancement of Medical Appropriateness and Quality of Care Uses a holistic approach to overcome barriers to meet goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• 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 knowledgeably participate with their provider in healthcare decision-making.
• Monitoring, Evaluation, and Documentation of Care Utilizes case management processes in compliance with regulatory and accreditation guidelines, as well as company policies and procedures.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level