Care Management Coordinator

CVS Health; Phoenix (AZ); Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Care Management Coordinator to enhance healthcare outcomes for members in Arizona. This full-time telework role involves critical thinking and collaboration to provide care coordination and support. You will conduct evaluations, implement care plans, and engage members in their healthcare decisions. Join a compassionate team dedicated to improving health and well-being while enjoying a flexible work schedule and comprehensive benefits. This is a fantastic opportunity for those passionate about making a difference in the community.

Benefits

Medical Plans

401(k)

Stock Purchase Plans

Wellness Programs

Paid Time Off

Flexible Schedules

Family Leave

Tuition Assistance

Qualifications

• 2+ years of experience in behavioral health or social services.
• Proficiency in MS Office applications and care management tools.

Responsibilities

• Conduct comprehensive evaluations of members' needs and eligibility.
• Coordinate and implement care plan activities and monitor progress.

Skills

Behavioral Health Experience

Social Services Experience

Negotiation Skills

Motivational Interviewing

Bilingual Skills

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 this 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, aiming to facilitate appropriate healthcare outcomes for members by providing care coordination, support, and education using care management tools and resources.
• At Mercy Care, our vision is for our members to live their healthiest lives and reach their full potential. Serving Arizonans of all ages eligible for Medicaid since 1985, we also serve those eligible for both Medicaid and Medicare. 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 with ours, join us to make a difference and improve health and wellbeing in Arizona.
• This position requires the ability to travel within the state up to 10% of the time.
• Flexibility to work beyond core hours of Monday-Friday, 8 am-5 pm, is required to meet the needs of adult members, which may include meetings after hours.

Evaluation of Members:

• Using care management tools and data review, conducts comprehensive evaluations of referred members' needs and eligibility, recommending approaches to meet these needs by assessing benefit plans and available programs/services.
• Identifies high-risk factors and service needs impacting member outcomes and care planning, referring to clinical care management or crisis intervention as appropriate.
• Coordinates and implements assigned care plan activities and monitors progress.

Enhancement of Medical Appropriateness and Quality of Care:

• Consults holistically with care managers, supervisors, Medical Directors, and other health programs to overcome barriers to achieving goals; presents cases at multidisciplinary reviews for optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Uses negotiation skills to secure appropriate options and services to meet member needs.
• Employs influencing and motivational interviewing skills to maximize member engagement and promote healthy lifestyle changes.
• Provides coaching, information, and support to empower members to make ongoing independent health decisions.
• Helps members actively participate with providers in healthcare decision-making.

Monitoring, Evaluation, and Documentation of Care:

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

Required Qualifications

• Minimum of 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 is required.
• Bachelor's degree or non-licensed master's level clinician in behavioral health or human services, or at least 4 years of relevant experience.

Preferred Qualifications

• Experience in care management and discharge planning.
• Managed Care experience.
• Pharmacy and pain management experience.
• Bilingual skills are 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.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range is $21.10 - $40.90 per hour. Actual salary depends on experience, education, location, and other factors. The role may include bonuses, commissions, or incentives.

We value our colleagues and offer comprehensive benefits, including medical plans, 401(k), stock purchase plans, wellness programs, paid time off, flexible schedules, family leave, dependent care, tuition assistance, and more. For details, visit https://jobs.cvshealth.com/us/en/benefits. The application deadline is 05/19/2025. Qualified applicants with criminal records will be considered per applicable laws.