Case Management Coordinator (West Valley, Arizona) ($5000 sign-on bonus)
About The Position
The Case Management Coordinator works from home and travels within Maricopa County, Arizona, to visit members. The role coordinates, documents, and communicates all aspects of the utilization and benefit management program. It applies critical thinking, clinically appropriate treatment knowledge, evidence-based care, and medical necessity criteria to provide members with care coordination, support, and education using care management tools and resources. The coordinator evaluates referred members’ needs and eligibility, identifies high-risk factors and service needs, develops and monitors care plan activities, and connects members with appropriate internal and external programs and services. The role supports medical appropriateness and quality of care through multidisciplinary case conferences, quality-of-care escalation, negotiation for appropriate services, motivational interviewing, coaching, and helping members participate in healthcare decisions. Case management processes must follow 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 West Valley, Arizona.
- Ability to travel up to 50% of the time within West Valley, Arizona.
- Bachelor’s degree or a valid Registered Nurse (RN) license in the state of Arizona.
Nice To Haves
- Previous experience working with members with a physical disability.
- Strong organizational and time management skills.
- Ability to collaborate with internal and external partners.
- Demonstrated proficiency in Microsoft Office Suite, including Outlook and Word.
- Previous experience collaborating with medical professionals.
- Bilingual in English and Spanish.
- Bachelor’s degree in Social Work, Psychology, Special Education, or Counseling.
Responsibilities
- Evaluate referred members’ needs and eligibility using care management tools and information and data review.
- Recommend approaches to resolve cases or meet 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 care goals and present cases at case conferences for multidisciplinary review.
- Identify and escalate quality-of-care issues through established channels.
- Use negotiation skills 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 decision-making.
- Use 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
- CVS Health bonus, commission, or short-term incentive program eligibility
- $5,000 sign-on bonus
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What This Job Offers
Job Type
Full-time
