Care Management Coordinator

Hispanic Alliance for Career Enhancement; Philadelphia (Philadelphia County); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player seeks a Care Management Coordinator to join their team in transforming healthcare. This full-time telework position requires critical thinking and collaboration to support members in achieving their health goals. You will conduct evaluations, coordinate care, and engage with members, ensuring they receive the best services possible. With a focus on quality and compassion, this role offers the opportunity to make a real difference in the lives of individuals. If you are passionate about healthcare and have experience in behavioral health, this could be the perfect fit for you.

Benefits

Affordable Medical Options

401(k) with Matching

Stock Purchase Plans

No-Cost Wellness Programs

Flexible Schedules

Tuition Assistance

Family Leave

Qualifications

• 2+ years in behavioral health or social services required.
• Proficiency in MS Office and care management tools necessary.

Responsibilities

• Conduct evaluations of members' needs and eligibility.
• Coordinate care plan activities and monitor progress.
• Consult with care managers and health programs for optimal outcomes.

Skills

Behavioral Health Experience

Social Services Experience

Computer Systems Navigation

MS Office Proficiency

Negotiation Skills

Motivational Interviewing

Education

Bachelor's Degree in Behavioral Health

Master's Degree in Human Services

4 Years Relevant Experience

Tools

MS Office (Word, Excel)

Care Management Tools

Job description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues — caring for people where, when, and how they choose in a way that is more connected, more convenient, and more compassionate. We do it all with heart, each and every day.

Position Summary

• The Care Management Coordinator is a full-time telework position with some travel required. This role involves critical thinking and judgment to collaborate and inform the care management process, facilitating appropriate healthcare outcomes by providing care coordination, support, and education to members through various tools and resources.
• At Mercy Care, our vision is for our members to live their healthiest lives and achieve their full potential. Serving Arizonans of all ages eligible for Medicaid since 1985, and also those eligible for both Medicaid and Medicare, Mercy Care is sponsored by Dignity Health and Ascension Health, and administered by Aetna, a CVS Health Business. We value diversity, compassion, innovation, collaboration, and advocacy. If your values align, let's work together to improve health and wellbeing in Arizona.
• This position requires travel within the state up to 10% of the time.
• Flexibility to work beyond core hours (Monday-Friday, 8am-5pm) is necessary to meet the needs of adult members, including after-hours meetings.

Evaluation of Members

• Using care management tools and data review, conduct comprehensive evaluations of referred members' needs and eligibility, and recommend approaches to case resolution or need fulfillment by assessing benefit plans and available programs/services.
• Identify high-risk factors and service needs impacting outcomes, and refer to clinical care management or crisis intervention as appropriate.
• Coordinate and implement care plan activities and monitor progress.

Enhancement of Medical Appropriateness and Quality of Care

• Consult with care managers, supervisors, Medical Directors, and other health programs to overcome barriers, presenting cases at conferences for multidisciplinary review to achieve optimal outcomes.
• Identify and escalate quality of care issues through established channels.
• Use negotiation skills to secure appropriate options and services to meet member needs.
• Apply motivational interviewing techniques to maximize member engagement and promote healthy lifestyle changes.
• Provide coaching, information, and support to empower members in making ongoing medical and lifestyle decisions.
• Encourage active and informed participation with providers in healthcare decisions.

Monitoring, Evaluation, and Documentation of Care

• Use care management and quality processes in compliance with regulatory, accreditation, and company policies.

Required Qualifications

• At least 2 years' experience in behavioral health and/or social services.
• Proficiency in navigating internal/external computer systems and MS Office applications, including Word and Excel.
• Residency in Arizona.
• Bachelor's degree or non-licensed master's level clinician in behavioral health or human services; or at least 4 years relevant experience.

Preferred Qualifications

• Experience in care management and discharge planning.
• Managed care experience.
• Pharmacy and pain management experience.
• Bilingual abilities preferred.

Education

• Bachelor's or master's degree in behavioral health or human services, or at least 4 years of relevant experience in lieu of a degree.

Additional Details

• Anticipated weekly hours: 40
• Time type: Full-time
• Pay range: $21.10 - $40.90 per hour, depending on experience, education, and location. Includes potential bonuses and incentives.

Our colleagues are our future. We foster a workplace where everyone feels valued and included.

Benefits

We offer comprehensive pay and benefits, including:

• Affordable medical options, 401(k) with matching, stock purchase plans.
• No-cost wellness programs, counseling, and coaching.
• Flexible schedules, family leave, dependent resources, tuition assistance, and more.

For more info, visit https://jobs.cvshealth.com/us/en/benefits

Application deadline: 05/19/2025.

Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.