Case Management Coordinator (Pima County, Arizona)

sed 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 or have a physical disability.
• Must reside in Pima County, Arizona.
• Ability to travel up to 50% of the time within Pima County, Arizona.

Preferred Qualifications

• 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).

• Bachelor's degree in Social Work, Psychology, Special Education, or Counseling.

Education

• Bachelor's degree or licensed RN (Registered Nurse), valid in the state of Arizona.

Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$21.10 - $40.90This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 01/29/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.