Case Management - Long Term Care; Field-AZ

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.

Schedule:

Monday-Friday 8:00am-5:00pm AZT (No weekends or holidays)

This role is work from home with 25-50% travel required in Eastern Maricopa County and Central, Northern and Southern Phoenix areas, AZ to visit members.

Are you passionate about making a meaningful difference in the lives of patients? Join Mercy Care as a Analyst, Case Management and become part of a mission-driven team that's transforming healthcare for Arizona's long term care population. In this full-time, field role, you'll 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 for members through the use of care management tools and resources.

• Utilizes skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
• 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 and company policies and procedures.

• This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

• 2+ years Case Management experience working with people who have been designated as having a serious mental illness (SMI) and working with people who are elderly or have a physical disability.

• Candidates must have earned a 4-year bachelor's degree in social work, psychology, special education or counseling.

Anticipated Weekly

Hours:

40

Time Type: Full time

The typical pay range for this role is:
$21.10 - $40.90
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed…