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Job Description & How to Apply Below
Field locations:
AZ - Work from hometime type:
Full time posted on:
Posted Todaytime left to apply:
End Date:
January 29, 2026 (13 days left to apply) job requisition :
R0811877
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.
** 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.
** Required Qualifications
*** 2+ years of experience in case management, 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.
* Must reside in Pima County, Arizona.
* Ability to travel up to 50% of the time within Pima County, Arizona.
** Preferred Qualifications
*** 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).
* Bachelor’s degree in Social Work, Psychology, Special Education, or Counseling.
** Education
* ** Bachelor’s degree or licensed RN (
* Registered Nurse*), valid in the state of Arizona.
** Anticipated Weekly Hours
** 40
* * Time Type
** Full time
** Pay Range
** 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. …
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