Case Management Coordinator (Pima County, Arizona) ($5000 sign-on bonus)

CVS Health•Work At Home-Arizona, AZ

9d•$21 - $41•Hybrid

About The Position

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 Case Management Coordinator is a work from home position with travel required (in Pima County, Arizona) to visit members. This person utilizes skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. They apply critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for members by providing care coordination, support, and education through the use of care management tools and resources. Job duties include (but are not limited to): 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 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 knowledgably 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.

Requirements

2+ years of experience in case management
Experience working with people who have been designated as having a serious mental illness (SMI)
Experience working with people who are elderly or have a physical disability.
Must reside in Pima County, Arizona.
Willingness to travel up to 50% of the time within Pima County, Arizona.

Nice To Haves

Strong organizational and time management skills.
Ability to collaborate with both internal and external partners.
Demonstrated proficiency in Microsoft Office Suite, including Outlook, Word, etc.
Previous experience collaborating with medical professionals.
Bilingual (English/Spanish).

Responsibilities

Conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs 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.
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 knowledgably participate with their provider in healthcare decision-making.
Utilizes case management processes in compliance with regulatory and accreditation guidelines, as well as company policies and procedures.