Case Management Coordinator (Maricopa County, Arizona) ($5000 sign-on bonus)
About The Position
The Case Management Coordinator is a work-from-home position with travel required to visit members in Maricopa County, Arizona. The coordinator uses care management tools and resources to coordinate, document, and communicate all aspects of the utilization and benefit management program. The role applies critical thinking and knowledge of clinically appropriate treatment, evidence-based care, and medical necessity criteria to provide members with care coordination, support, and education. The coordinator evaluates members’ needs and eligibility, recommends approaches to resolve cases or meet needs, identifies high-risk factors and service needs, and coordinates and monitors care plan activities. The role also works to improve medical appropriateness and quality of care through multidisciplinary case conferences, escalation of quality concerns, negotiation for appropriate services, motivational interviewing, coaching, and support for members’ healthcare decisions. Case management processes must comply with regulatory and accreditation guidelines and company policies and procedures.
Requirements
- At least 2 years of experience in case management.
- Experience working with people designated as having a serious mental illness (SMI).
- Experience working with elderly people.
- Must reside in Maricopa County, Arizona.
- Willingness to travel up to 50% of the time within Maricopa County, Arizona.
- Bachelor’s degree in Social Work, Psychology, Special Education, or Counseling, or a valid Arizona licensed Registered Nurse (RN).
Nice To Haves
- Residence in West Valley, Maricopa County, Arizona.
- Previous experience working with members with a physical disability.
- Strong organizational and time management skills.
- Ability to collaborate with internal and external partners.
- Proficiency in Microsoft Office Suite, including Outlook and Word.
- Previous experience collaborating with medical professionals.
- Bilingual in English and Spanish.
Responsibilities
- Conduct comprehensive evaluations of referred members’ needs and eligibility using care management tools and information or data review.
- Recommend approaches to case resolution and meeting member needs by evaluating benefit plans and available internal and external programs and services.
- Identify high-risk factors and service needs that may affect member outcomes and care planning, and make appropriate referrals.
- Coordinate and implement assigned care plan activities and monitor progress.
- Use a holistic approach to address barriers to goals and objectives.
- Present cases at case conferences for multidisciplinary review and optimal outcomes.
- Identify and escalate quality-of-care issues through established channels.
- Negotiate to secure appropriate options and services that meet members’ benefit and healthcare needs.
- Use influencing and motivational interviewing skills to engage members and promote lifestyle or behavior changes.
- Provide coaching, information, and support to empower members to make independent medical and healthy-lifestyle choices.
- Help members participate actively and knowledgeably with providers in healthcare decisions.
- Apply case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
- Eligible for a CVS Health bonus, commission, or short-term incentive program
- $5,000 sign-on bonus
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
