Case Management Coordinator; Maricopa County, Arizona)

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.

The Case Management Coordinator is a work-at-home position, working with contracted providers in Phoenix, Arizona. Please note that 25% of the work week will be spent at provider offices, with 75% of the work week spent  Mercy Care RBHA (Regional Behavioral Health Authority) Care Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support, and education for members through the use of care management tools and resources.

Care Management Coordinators utilize knowledge of program requirements, network, and community resources to facilitate appropriate physical and behavioral healthcare and social services for members through collaboration with internal and external providers. The Mercy Care RBHA Care Management Coordinator supports integrated care for the members, which centers on targeting social determinants of health concerns. 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, determined 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 knowledgeably 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.

• 2+ years of experience in behavioral health.
• Must reside in Maricopa County, Arizona.
• Ability travel to providers’ offices up to 25% of the time within Phoenix, Arizona.

• Case management and discharge planning experience.
• Managed Care experience.
• Non-licensed Master’s level clinician.

Bachelor's degree.

40

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…