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.
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.
- Willingness 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
40Time Type
Full timePay Range
The typical pay range for this role is:
$21.10 - $40.90This 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 including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- 2+ years of case management experience working with individuals designated as having serious mental illness and with elderly or physically disabled populations
- Must reside in Pima County, Arizona
- Willingness to travel up to 50% of the time within Pima County, Arizona
- Bachelor's degree or licensed Registered Nurse valid in the state of Arizona
- Strong organizational and time management skills
- Ability to collaborate with internal and external partners and prior experience collaborating with medical professionals
- Demonstrated proficiency in Microsoft Office Suite (Outlook, Word, etc.)
- Bilingual English/Spanish
- Bachelor's degree in Social Work, Psychology, Special Education, or Counseling
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
