[Hiring] Case Management - Long Term Care @CVS Health

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Are you passionate about making a meaningful difference in the lives of patients? Join Mercy Care as a Analyst, Case Management and become part of a mission-driven team that’s transforming healthcare for Arizona’s long term care population. In this full-time, field role, you'll 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.

• Utilizes skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
• Evaluation of Members:
• Conducts comprehensive evaluation of referred member’s needs/eligibility.
• 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.
• Utilizes case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Qualifications

• 2+ years Case Management experience 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.
• Candidates must have earned a 4-year bachelor’s degree in social work, psychology, special education or counseling.

Requirements

• Schedule: Monday–Friday 8:00am-5:00pm AZT (No weekends or holidays).
• This role is work from home with 25-50% travel required in Eastern Maricopa County and Central, Northern and Southern Phoenix areas, AZ to visit members.
• This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

Benefits

• Affordable medical plan options.
• 401(k) plan (including matching company contributions).
• Employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

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