CVS Health · 5 hours ago

Case Management Analyst - Maricopa County and Phoenix Area

Greater Phoenix Area

Full-time

Remote

Entry, Mid Level

$21.10/hr - $36.78/hr

2+ years exp

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Responsibilities

Utilizes skills to coordinate, document and communicate all aspects of the utilization/benefit management program.

Applies 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.

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.

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.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Case ManagementCare CoordinationHolistic ApproachMotivational InterviewingComputer ProficiencySocial WorkPsychologySpecial EducationCounselingRegistered Nurse

Required

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.

Critical areas to succeed- organization, collaboration and time management.

Reliable transportation required (Mileage is reimbursed per our company expense reimbursement policy).