Description
We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.
The Case Management Coordinator is a work-from-home position with travel required in Pinal and Maricopa Counties, Arizona, to visit members. This role utilises skills to coordinate, document, and communicate all aspects of the utilisation/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:
- Evaluation of Members: Conduct comprehensive evaluations of referred members' needs/eligibility using care management tools and information/data review. Recommend approaches to case resolution and/or meeting needs by evaluating members' benefit plans and available internal and external programs/services. Identify high-risk factors and service needs that may impact member outcomes and care planning components with appropriate referrals.
- Enhancement of Medical Appropriateness and Quality of Care: Use a holistic approach to overcome barriers to meet goals and objectives. Present cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes. Identify and escalate quality of care issues through established channels. Utilise negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
- Monitoring, Evaluation, and Documentation of Care: Utilise 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 or have a physical disability.
- Must reside in Pinal County, Arizona.
- Ability to travel up to 50% of the time within Pinal and Maricopa Counties, Arizona.
Preferred Qualifications:
- Strong organisational 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 Counselling, or licensed RN (Registered Nurse), valid in the state of Arizona.
Anticipated Weekly Hours: 40
Time Type: Full-time
Pay Range: $21.10 - $40.90
Benefits: This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.