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

CVS Health•Work At Home-Arizona, AZ

7d•$21 - $41•Remote

About The Position

The Case Management Coordinator is a work-from-home role requiring travel within Pinal and Maricopa Counties, Arizona, to visit members. The coordinator uses care management tools and resources to coordinate, document, and communicate utilization and benefit management activities. 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 referred members’ needs and eligibility, considers benefit plans and available internal and external programs, identifies risks and service needs, and helps develop and monitor care plans. The role also works to overcome barriers to care, participates in multidisciplinary case conferences, escalates quality-of-care concerns, secures appropriate services, and supports members in making informed healthcare and lifestyle choices. Case management activities 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 people who are elderly or have a physical disability.
Must reside in Pinal County, Arizona.
Ability to travel up to 50% of the time within Pinal and Maricopa Counties, Arizona.
Bachelor’s degree in Social Work, Psychology, Special Education, or Counseling, or an Arizona-valid licensed RN credential.

Nice To Haves

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.

Responsibilities

Evaluate referred members’ needs and eligibility using care management tools and information or 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 overcome barriers to care and meet member goals and objectives.
Present cases at case conferences to obtain multidisciplinary review and support optimal outcomes.
Identify and escalate quality-of-care issues through established channels.
Use negotiation skills to secure appropriate options and services that meet members’ benefits and healthcare needs.
Use influencing and motivational interviewing skills to encourage member engagement and healthy lifestyle or behavior changes.
Provide coaching, information, and support to help members 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.