Clinical Case Manager Behavioral Health

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

About the Role

Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Responsibilities

• Assessment of Members:
  • Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member’s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
  • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.
  • Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
  • Provides crisis follow-up to members to help ensure they are receiving the appropriate treatment/services.
• Enhancement of Medical Appropriateness and Quality of Care:
  • Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
  • Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes.
  • Identifies and escalates quality of care issues through established channels.
  • Ability to speak to medical and behavioral health professionals to influence appropriate member care.
  • Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes 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.
  • Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
• Monitoring, Evaluation and Documentation of Care:
  • In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals.
  • Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
  • Ability to take and manage crisis calls.

Requirements

• Unencumbered Independent Behavioral Health clinical license in the state where they reside and work:
  • Licensed Mental Health Counselor (LMHC)
  • Licensed Clinical Social Worker (LCSW)
  • Licensed Independent Social Worker (LISW)
  • Licensed Marital and Family Therapist (LMFT)
  • Licensed Master Social Worker (LMSW)
  • Licensed Professional Counselor (LPC)
  • Licensed Social Worker (LSW)
• 3+ years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.
• 3+ years minimum of Behavioral Health experience.
• Applicants must be willing to work standard business hours in EST or CST.

Preferred Qualifications

• Case management and discharge planning experience.
• Crisis intervention skills.
• Managed care/utilization review experience.
• Ability to take and manage crisis calls.

Education

Minimum of a Master’s degree in Behavioral/Mental Health or related field.

Pay

The typical pay range for this role is $54,095.00 - $116,760.00. This pay range represents the 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.

Benefits

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.

Schedule

• Full time.
• 40 anticipated weekly hours.