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Position Description:

Applicants must reside in Maricopa County, AZ.
Travel local within city limits up to 10% weekly to visit assigned sites.

Working Hours: Monday-Friday 8am -5pm. No nights, no weekends and no holidays! Opportunity to work 4/10’s within 6 months, if meeting all qualifications/benchmarks.

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.

The Care Manager is responsible for working with the assigned behavioral health direct care clinic and addressing high utilizing members for gaps in care. Care managers work with direct care clinic staff on members as well as external PCP’s, specialists, and DME companies on bringing together medical and behavioral health in all aspects.
Evaluation of Members;
-Through the use of care management tools and information/data review, conducts a 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 the optimum level of health.
-Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
-Helps members actively and knowledgeably participate with their providers 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.

Required Qualifications:

• Must reside within Maricopa County, Arizona
• Unencumbered Behavioral Health clinical license in the state of AZ (i.e. LPC, LISAC, LCSW, LAC, LMSW)
• 3+ years of direct clinical practice experience in behavioral health
• 2+ years’ Case Management experience
• 2+ years’ experience working with people who have been designated as having a serious mental illness (SMI)
• Willing and able to travel once per week or up to 10% of the time to visit assigned site locations

Preferred Qualifications

• Experience with Microsoft Suite:  Word, Excel, PowerPoint, Outlook, Teams
• Managed care/utilization review experience
• Discharge planning experience
• Crisis intervention skills
• Sophisticated Time management, organizational skill set, and ability to multi-task is a must. 
• Excellent communication skills in writing and verbally
• Ability to quickly learn several operating systems for data entry and authorizations.
• Experience collaborating with medical professionals
• Team Player

Education:

• Master’s degree in Behavioral/Mental health field

Pay Range

The typical pay range for this role is:

$54,095.60 - $116,760.80

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 11/30/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.