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Position Summary

• Consults with case managers, supervisors, medical directors and/or other health programs using a holistic approach.
• Presents cases at case conferences to obtain a multidisciplinary review in order to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Demonstrates negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
• Delivers 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.
• Assists in encouraging members to actively participate with their provider in healthcare decision-making.
• Conducts comprehensive evaluations of referred members' needs/eligibility using care management tools and recommends an approach to case resolution.
  
  Monday-Friday, 8am-5pm.
  
  Work from home with requirement to reside in Arizona with travel to the Phoenix office for meetings approximately twice a year.
  
  This position utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
  
  At Mercy Care, our vision is for our members to live their healthiest lives and achieve their full potential. We're a local company, serving Arizonans of all ages who are eligible for Medicaid since 1985. We also serve people who are eligible for both Medicaid and Medicare. Mercy Care is sponsored by Dignity Health and Ascension Health and is administered by Aetna, a CVS Health Business. In April 2021 we began delivering integrated physical and behavioral health services to children involved with the child welfare system, in a unique partnership with the Arizona Department of Child Safety and their Comprehensive Health Plan. We value diversity, compassion, innovation, collaboration, and advocacy. If your values are the same as ours, let's work together to make a difference and improve the health and wellbeing of Arizona.
  
  Travel to office- based meetings in Phoenix approximately 2 times per year. Reliable transportation required.
  
  We are serving the needs of children and families that may require meeting after school, after work, etc.
  Fundamental Components:
  • Evaluation of Members:
  o 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.
  o Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
  o Coordinates and implements assigned care plan activities and monitors care plan progress.
  
  • Enhancement of Medical Appropriateness and Quality of Care:
  o Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes.
  o Identifies and escalates quality of care issues through established channels.
  o Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
  o Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
  o Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
  o Helps member actively and knowledgably participate with their provider in healthcare decision-making.
  • Monitoring, Evaluation and Documentation of Care:
  o Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

• Basic awareness of problem solving and decision making skills
• 1-2 years related work experience
• Travel to office- based meetings in Phoenix approximately 2 times per year. Reliable transportation required.

• Experience working with Department of Developmental Disabilities, (DDD)
• 2+ years related work experience
  
  Education
  Bachelor's degree