Remote Case Management Coordinator

CVS Health; 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

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.