Care Management Coordinator ID-7059
- $21 to $41 Hourly
- Vision , Medical , Dental , Paid Time Off , Life Insurance , Retirement
- Full-Time
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
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Position Summary
- The Care Management Coordinator is a full time telework position with some travel required. This position utilizes critical thinking and judgment to collaborate and inform the care 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.
- At Mercy Care, our vision is for our members to live their healthiest lives and achieve their full potential. We're a local company, serving Arizonans of all ages who are eligible for Medicaid since 1985. We also serve people who are eligible for both Medicaid and Medicare. Mercy Care is sponsored by Dignity Health and Ascension Health and is administered by Aetna, a CVS Health Business. We value diversity, compassion, innovation, collaboration and advocacy. If your values are the same as ours, let's work together to make a difference and improve the health and wellbeing of Arizona.
- This position requires the ability to travel in state up to 10% of the time.
- Flexibility to work beyond the core business hours of Monday-Friday, 8am-5pm, is required. We are serving the needs of adults that may require meeting after after work, etc.
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 referral to clinical care management or crisis intervention as appropriate.
- Coordinates and implements assigned care plan activities and monitors care plan progress.
Enhancement of Medical Appropriateness and Quality of Care:
- Using holistic approach consults with care managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting 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 care management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Required Qualifications
- 2 years' experience in behavioral health and/or social services.
- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
- Must be reside in Arizona
- Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services; OR at least 4 years relevant experience
Preferred Qualifications
- Care management and discharge planning experience preferred.
- Managed Care experience preferred.
- Pharmacy and pain management experience preferred
- Bilingual preferred
Education
- A Bachelor's degree, a master's degree with either being in behavioral health or human services area of study, OR at least 4 years relevant experience in lieu of a degree.
Anticipated Weekly Hours
