Case Management Coordinator

2 weeks ago

Phoenix, Arizona, United States CVS Health Full time
Job Title: Case Management Coordinator

At CVS Health, we're committed to delivering exceptional healthcare services that make a meaningful difference in people's lives. As a Case Management Coordinator, you'll play a vital role in helping us achieve this mission.

About the Role

This is a work-from-home position with travel required in Maricopa County, Arizona to visit members. As a Case Management Coordinator, you'll support members in achieving their personal healthcare goals while providing education and support to help them reach these objectives.

Key Responsibilities
  • Utilize your skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
  • 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.
  • Evaluate members' needs and eligibility, and recommend an approach to case resolution and/or meeting needs by evaluating members' benefit plans and available internal and external programs/services.
  • Identify high-risk factors and service needs that may impact member outcomes and care planning components with appropriate referrals.
  • Coordinate and implement assigned care plan activities and monitor care plan progress.
  • Enhance medical appropriateness and quality of care by using a holistic approach to overcome barriers to meet goals and objectives, presenting cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes.
  • Identify and escalate quality of care issues through established channels.
  • Utilize negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
  • Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
  • Provide coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
  • Help members actively and knowledgeably participate with their provider in healthcare decision-making.
Requirements
  • 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.
  • Strong organizational skills with an ability to prioritize tasks to meet time-sensitive deadlines.
  • Effective verbal and written communications skills with both customers and teammates.
  • 1+ years of experience with computers, including knowledge of Microsoft Word, Outlook, and Teams.
  • Ability to work independently.
  • Must be located in the West Valley of the Phoenix metropolitan area and be able to travel up to 50%.
Preferred Qualifications
  • Experience collaborating with medical professionals.
  • Education: Bachelor's degree, preferred in social work, psychology, special education, or counseling, or be a licensed registered nurse.
What We Offer

At CVS Health, we're committed to providing a comprehensive benefits package that includes medical, dental, and vision benefits, a 401(k) retirement savings plan, and an Employee Stock Purchase Plan. We also offer numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.

We're an equal opportunity and affirmative action employer, and we welcome applications from qualified candidates with arrest or conviction records. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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