Job Description
Qualifying candidates may be eligible for a sign on bonus of up to $5,000.

This role is work from home with 25% travel required in Central Phoenix/West Maricopa County, AZ.

Working schedule: Monday - Friday, 8am - 5 pm

Mercy Care is a not-for-profit Medicaid managed-care health plan, serving Arizonans since 1985. We provide access to physical and behavioral health care services, to people who are eligible for Medicaid. Our members include families, children, seniors, and individuals who have developmental/cognitive disabilities. We hold multiple contracts with AHCCCS, Arizona’s Medicaid agency, and deliver services throughout the state.

Mercy Care is administered by Aetna, a CVS Health company. Our staff is employed by Aetna and CVS Health. This gives Mercy Care the resources of a national organization, and still allows us to bring our members the familiarity and presence of a local team of people who put our members at the center of everything we do.

• 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.

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 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. Monitoring,

Evaluation, and Documentation of Care:

• Utilizes case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

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

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Pay Range
The typical pay range for this role is:
Minimum: 19.50
Maximum: 40.10

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

• 2+ years of 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.

Preferred Qualifications
- 1+ year(s) of experience documenting electronically using keyboard and multiple computer screens- navigating through internal/external computer systems, and MS Office Suite applications, including Word and Excel

• 1+ year(s) of experience collaborating with medical professionals
• 1+ year(s) of case management experience

Education

• 4-year bachelor’s degree required in social work, psychology, special education, or counseling, or be a licensed registered nurse.

Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.