Case Manager (Arizona)

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 uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary
This Case Manager (Arizona) is a remote position with travel required, specifically in Central Maricopa County and the greater Phoenix area.

In this role, you will:

• Utilize skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
• 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 for members through the use of care management tools and resources.
• Evaluate members through the use of care management tools and information/data review, conduct comprehensive evaluation of referred member’s needs/eligibility, and recommend an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
• Identify high-risk factors and service needs that may impact member outcomes and care planning components with appropriate referrals.
• Coordinate and implement assigned care plan activities and monitor care plan progress.
• Use a holistic approach to overcome barriers to meet goals and objectives; present cases at case conferences to obtain multidisciplinary review, in order to achieve optimal outcomes.
• Identify and escalate quality of care issues through established channels.
• Utilize negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provide coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Help member actively and knowledgably participate with their provider in healthcare decision-making.
• Utilize case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

• 2+ years of experience in case management, specifically working with people who have been designated as having a serious mental illness (SMI) and/or working with people who are elderly and/or have a physical disability.
• Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook).
• Must reside in Arizona, specifically within Maricopa or Pinal counties.
• Ability to travel 50% of time within Maricopa or Pinal counties.

Preferred Qualifications

• Strong organizational skills.
• Strong time management skills.
• Ability to regularly collaborate and coordinate with various team members.
• Previous experience collaborating with medical professionals.
• Bilingual (English/Spanish).

Education

• Bachelor’s degree in social work, psychology, special education, or counseling.

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. 
 

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

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a