Job Description
Job Description
The CHP Case Management Coordinator is an Arizona based full time telework position, with some travel required. This position 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.
At Mercy Care, our vision is for our members to live their healthiest lives and achieve their full potential. Were 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. In April 2021 we began delivering integrated physical and behavioral health services to children involved with the child welfare system, in a unique partnership with the Arizona Department of Child Safety and their Comprehensive Health Plan. We value diversity, compassion, innovation, collaboration and advocacy. If your values are the same as ours, lets work together to make a difference and improve the health and wellbeing of Arizona.
This position requires the ability to travel in state with a personal vehicle up to 10% of the time. Qualified candidates must have a valid AZ driver's license, reliable transportation, and proof of vehicle insurance.
Flexibility to work beyond the core business hours of Monday-Friday, 8am-5pm, is required. We are serving the needs of children and families that may require meeting after school, after work, etc.
Fundamental Components:
* Evaluation of Members:
- Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members 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 case 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 case 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 members 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 and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Required Qualifications
* 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus.
* 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 Arizona based.
Preferred Qualifications
* Case management and discharge planning experience preferred.
* Managed Care experience preferred.
* Bilingual preferred.
Education
* Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
The CHP Case Management Coordinator is an Arizona based full time telework position, with some travel required. This position 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.
At Mercy Care, our vision is for our members to live their healthiest lives and achieve their full potential. Were 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. In April 2021 we began delivering integrated physical and behavioral health services to children involved with the child welfare system, in a unique partnership with the Arizona Department of Child Safety and their Comprehensive Health Plan. We value diversity, compassion, innovation, collaboration and advocacy. If your values are the same as ours, lets work together to make a difference and improve the health and wellbeing of Arizona.
This position requires the ability to travel in state with a personal vehicle up to 10% of the time. Qualified candidates must have a valid AZ driver's license, reliable transportation, and proof of vehicle insurance.
Flexibility to work beyond the core business hours of Monday-Friday, 8am-5pm, is required. We are serving the needs of children and families that may require meeting after school, after work, etc.
Fundamental Components:
* Evaluation of Members:
- Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members 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 case 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 case 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 members 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 and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Required Qualifications
* 2 years experience in behavioral health, social services or appropriate related field equivalent to program focus.
* 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 Arizona based.
Preferred Qualifications
* Case management and discharge planning experience preferred.
* Managed Care experience preferred.
* Bilingual preferred.
Education
* Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
46320846