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Position Summary
The Clinical Case Manager, Behavioral Health is a full-time telework role, open to candidates located within Maricopa County, 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, Arizonas 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.
Primary Responsibilities
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 members needs/eligibility and recommend an approach to case resolution and/or meeting needs, particularly by evaluating members 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 members 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.
Required Qualifications
Preferred Qualifications
Education
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$60,522.00 - $129,615.00
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.
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 people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
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.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 05/25/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all.