Clinical Case Manager, Behavioral Health (West Valley, Arizona)

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Summary The Clinical Case Manager, Behavioral Health is a full-time telework role, open to candidates located within West Valley, Arizona. This role will require up to 25-50% travel within West Valley, including member visits and office work. 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, specifically 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.

General Utilize clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. Apply critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for members, specifically by providing care coordination, support, and member education through the use of care management tools and resources. Evaluation of Members Through the use of care management tools and information/data review, conduct comprehensive evaluation of referred member’s needs/eligibility and recommend an approach to case resolution and/or meeting needs, particularly by evaluating member’s benefit plan, as well as 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. Coordinate and implement assigned care plan activities and monitor care plan progress. 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, in order to achieve optimal outcomes. Identify and escalate quality of care issues through established channels. Utilize negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs. Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes, in order to achieve optimum level of health. Provide coaching, information, and support to empower the member to make ongoing, independent medical and/or healthy lifestyle choices. Help members actively and knowledgably participate with their provider in healthcare decision-making. Monitoring, Evaluation, and Documentation of Care Utilize case management processes in compliance with regulatory and accreditation guidelines, as well as company policies and procedures.

Active and good standing Arizona clinical and/or counseling license, specifically LPC ( Licensed Professional Counselor ), LAC ( Licensed Associate Counselor ), LMSW ( Licensed Master Social Worker ), LCSW ( Licensed Clinical Social Worker ), and/or LISAC ( Licensed Independent Substance Abuse Counselor ). 3+ years of direct clinical practice experience. 2+ years of case management experience, specifically working with people who have been