Care Management Coordinator

at  CVS Health

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.
Position Summary
Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members. Helps implement projects, programs, and processes for Case Management. Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area.

REQUIRED QUALIFICATIONS

• Basic awareness of problem solving and decision making skills
• 1-2 years related work experience
• Travel to office- based meetings in Phoenix approximately 2 times per year. Reliable transportation required.

PREFERRED QUALIFICATIONS

• Experience working with Department of Developmental Disabilities, (DDD)
• 2+ years related work experienceEDUCATIONBachelor’s degree

o Helps member actively and knowledgably participate with their provider in healthcare decision-making.

• Monitoring, Evaluation and Documentation of Care

• Consults with case managers, supervisors, medical directors and/or other health programs using a holistic approach.
• Presents cases at case conferences to obtain a multidisciplinary review in order to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Demonstrates negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• Delivers 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.
• Assists in encouraging members to actively participate with their provider in healthcare decision-making.
• Conducts comprehensive evaluations of referred members’ needs/eligibility using care management tools and recommends an approach to case resolution.
  Monday-Friday, 8am-5pm.
  Work from home with requirement to reside in Arizona with travel to the Phoenix office for meetings approximately twice a year.
  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. 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. 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, let’s work together to make a difference and improve the health and wellbeing of Arizona.
  Travel to office- based meetings in Phoenix approximately 2 times per year. Reliable transportation required.
  We are serving the needs of children and families that may require meeting after school, after work, etc.

Fundamental Components:

• Evaluation of Members:

o 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.
o 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.

o Coordinates and implements assigned care plan activities and monitors care plan progress.

• Enhancement of Medical Appropriateness and Quality of Care:

o 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 to achieve optimal outcomes.
o Identifies and escalates quality of care issues through established channels.
o Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
o Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
o Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

o Helps member actively and knowledgably participate with their provider in healthcare decision-making.

• Monitoring, Evaluation and Documentation of Care:

o Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.