Case Management Coordinator (West Valley, Arizona) ($5000 sign-on bonus)

CVS Health; Yuma (AZ); Remote; USD 60.000 - 80.000; Vollzeit

Zusammenfassung

CVS Health is seeking a Case Management Coordinator for a remote role with travel required to visit members in Maricopa County, Arizona. You will coordinate, document, and communicate all aspects of the utilization/benefit management program, applying clinical judgment and evidence-based care to support members.

In this role you will assess member needs, coordinate care plans, and collaborate with care teams to ensure medical necessity and high-quality outcomes while maintaining a

Aufgaben

• Evaluation of Members: 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.

Jobbeschreibung

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 Maricopa County, 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 include (but are not limited to):

• 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