Position Summary

This role is work from home with travel required in Eastern and Central Maricopa county and Phoenix area to visit members. The Case Management Coordinator supports in making personal health care goals. At the same time, they provide education and support to help members reach these goals. This approach helps maintain and improve members level of function, health, and quality of life.

What you will 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.

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Required 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.
• Strong organizational skills with an ability to prioritize tasks to meet time-sensitive deadlines.
• Effective verbal and written communications skills with both customers and teammates.
• 1+ years of experience with computers including knowledge of Microsoft Word, Outlook and TEAMs.
• Ability to work independently
• Must be located in the East Valley of the Phoenix metropolitan area and be able to travel up to 50%.

Preferred Qualifications

• Experience collaborating with medical professionals

Education

• Bachelor’s degree, preferred in social work, psychology, special education, or counseling, or be a licensed registered nurse.