Case Management Coordinator (Pinal County, Arizona) ($5000 sign-on bonus)

4004 Aetna Medicaid Administrators; Arizona; Hybrid; USD 29,000 - 56,000; Full time

Benefits offered by this job

Comprehensive benefits package

Job summary

CVS Health is seeking a Case Management Coordinator for a work-from-home role with travel required in Pinal and Maricopa Counties, Arizona. You will coordinate, document, and communicate all aspects of utilization/benefit management, applying evidence-based care and medical necessity criteria to support members.

Responsibilities include evaluating member needs, coordinating care plans, improving quality of care, negotiating services, and coaching members toward healthier choices.

Qualifications

• 2+ years of experience in case management, working with people who have been designated as having a serious mental illness (SMI) and working with people who are elderly or have a physical disability.
• Must reside in Pinal County, Arizona.
• Ability to travel up to 50% of the time within Pinal and Maricopa Counties, Arizona.

Responsibilities

• Evaluate members and determine needs/eligibility, and recommend an approach to case resolution.
• Coordinate and implement assigned care plan activities and monitor progress.
• Improve medical appropriateness and quality of care through holistic care and multidisciplinary review.
• Negotiate options and services to meet member benefits and healthcare needs.
• Use motivational interviewing to maximize member engagement and promote healthy changes.
• Provide coaching and support to empower informed medical and lifestyle choices.
• Help members participate with their providers in decision making.
• Document care in compliance with regulatory guidelines and company policies.

Skills

Case management

Care coordination

Communication

Travel readiness

Education

Bachelor’s degree in Social Work, Psychology, Special Education, or Counseling, or licensed RN

Tools

Microsoft Office Suite

Outlook

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Case Management Coordinator is a work from home position with travel required (in Pinal and Maricopa Counties, Arizona) to visit members. This person utilizes skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. They apply critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for members by providing care coordination, support, and education through the use of care management tools and resources.

Job Duties

• Evaluation of Members: 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. 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 member’s 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 processes in compliance with regulatory and accreditation guidelines, as well as company policies and procedures.

Required Qualifications

• 2+ years of experience in case management, working with people who have been designated as having a serious mental illness (SMI) and working with people who are elderly or have a physical disability.
• Must reside in Pinal County, Arizona.
• Ability to travel up to 50% of the time within Pinal and Maricopa Counties, Arizona.

Preferred Qualifications

• Strong organizational and time management skills.
• Ability to collaborate with both internal and external partners.
• Demonstrated proficiency in Microsoft Office Suite, including Outlook, Word, etc.
• Previous experience collaborating with medical professionals.
• Bilingual (English/Spanish).

Education

• Bachelor’s degree in Social Work, Psychology, Special Education, or Counseling, or licensed RN (Registered Nurse), valid in the state of Arizona.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $21.10 - $40.90. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Benefits

Great benefits for great people: We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

Application Window

We anticipate the application window for this opening will close on: 11/16/2026

Eligibility

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Company Culture

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people. Our work experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.