Intensive Case Manager- Field- Must reside in Jefferson County, KY

Evaluation of Members

Through the use of care management assessments and information/data review, recommends an approach to resolving care needs maintaining optimal health and well-being 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 implements early and proactive support interventions.

Enhancement Of Medical Appropriateness And Quality Of Care

Using a 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 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.

Monitoring, Evaluation And Documentation Of Care

Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Qualifications

• Minimum 6 months experience in Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services or evidence-based practices applicable to the Kentucky SKY populations, is required.
• Minimum 2 year of experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
• Minimum 1 year of experience in MS Office Suite applications, including Word and Excel.
• Willing and able to travel 80-90% of their time to meet members face to face in their assigned region.
• Candidate must reside in: Jefferson County

Preferred Qualifications

• 3+ years' experience required in behavioral health, social services, social work, psychology, sociology, marriage and family therapy, or counseling.
• 1+ MCO experience.

Education

• Minimum of a Bachelor’s Master’s degree or a non-licensed master level clinician is required; with either degree being in behavioral health or a relevant human services field of study required (social work, psychology, marriage and family therapy, counseling).

Pay Range

The Typical Pay Range For This Role Is $21.10 - $36.78 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.