Position Summary
The Case Management Coordinator is a work from home position with travel required (in Maricopa County, Arizona) to visit members. This person utilizes skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. They 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 through the use of care management tools and resources.
Job duties include (but are not limited to)
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, as well as company policies and procedures.
Required 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.
- Must reside in Maricopa County, Arizona.
- Willingness to travel up to 50% of the time within Maricopa County, Arizona.
Preferred Qualifications
- Resides in West Valley, Maricopa County, AZ.
- Previous experience working with members with a physical disability.
- Strong organizational and time management skills.
- Ability to collaborate with both internal and external partners.
- Demonstrated proficiency in Microsoft Office Suite, including Outlook, Word, etc.
- Previous experience collaborating with medical professionals.
- Bilingual (English/Spanish).
Education
- Bachelor's degree in Social Work, Psychology, Special Education, or Counseling, or licensed RN (Registered Nurse), valid in the state of Arizona.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is
$21.10 - $40.90