Case Management Coordinator
This is a community based position working in a contracted providers office in Phoenix, AZ 75% of the work week with 25% of work week at home or office.
Mercy Care RBHA care manager 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.
Mercy Care RBHA care manager utilizes knowledge of program requirements, network and community resources to facilitate appropriate physical and behavioral healthcare and social services for members through collaboration with internal and external providers. Mercy Care RBHA care manager supports integrated care for the members, which centers on targeting social determinants of health concerns.
- 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 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 members benefits and/or
- 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 knowledgeably 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 and company policies and procedures.
- 2+ years of experience in behavioral health or social services required
- A minimum of a Bachelor's degree or non-licensed master level clinician required
- Case management and discharge planning experience preferred
- Managed Care experience preferred
-Managed care experience preferred
-Case management and discharge planning experience preferred
-Experience working with behavioral health members preferred
Bachelor's level degree required, preferably in medical or behavioral health field.
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.