Case Management Coordinator

• Conduct comprehensive evaluations of referred members’ needs and eligibility using care management tools and data review
• Recommend case-resolution approaches by evaluating benefit plans and internal and external programs or services
• Identify high-risk factors and service needs affecting member outcomes and care planning
• Make appropriate referrals and coordinate assigned care-plan activities
• Monitor care-plan progress
• Use a holistic approach to overcome barriers and meet goals and objectives
• Present cases at case conferences for multidisciplinary review
• Identify and escalate quality-of-care issues through established channels
• Negotiate appropriate options and services to meet members’ benefit and healthcare needs
• Use influencing and motivational-interviewing skills to engage members and promote lifestyle or behavior changes
• Provide coaching, information, and support for independent medical and healthy-lifestyle choices
• Support members in participating knowledgeably in healthcare decisions with providers
• Apply case-management processes in compliance with regulatory, accreditation, and company requirements
• Coordinate, document, and communicate aspects of the utilization and benefit-management program

• 2+ years of experience in case management
• Experience working with people designated as having serious mental illness (SMI)
• Experience working with elderly people or people with a physical disability
• Must reside in Pima County, Arizona
• Ability to travel up to 50% of the time within Pima County, Arizona
• Strong organizational and time-management skills
• Ability to collaborate with internal and external partners
• Proficiency in Microsoft Office Suite, including Outlook and Word
• Previous experience collaborating with medical professionals
• Bachelor’s degree in Social Work, Psychology, Special Education, or Counseling, or a valid Arizona licensed RN
• Bilingual English/Spanish listed as preferred

Demonstrates expertise in case management processes, including comprehensive evaluations, care planning, and coordination of services for members with serious mental illness and physical disabilities. Proficient in utilizing motivational interviewing and collaboration with healthcare professionals to enhance member outcomes.

• Case Management
• Motivational Interviewing
• Care Planning
• Bilingual English/Spanish
• Microsoft Office Suite

• Case Management Processes
• Comprehensive Evaluations
• Benefit Plan Evaluation
• Holistic Approach
• Quality-of-Care Issue Identification
• Documentation and Communication
• Utilization Management
• Data Review
• Referral Coordination
• Organizational Skills

• Collaboration
• Time Management
• Influencing Skills
• Coaching
• Supportive Communication

• Bachelor’s Degree in Social Work
• Bachelor’s Degree in Psychology
• Bachelor’s Degree in Special Education
• Bachelor’s Degree in Counseling
• Arizona Licensed RN

• Serious Mental Illness
• Elderly Care
• Physical Disability
• Healthcare Decisions
• Pima County, Arizona