CVS Health

- Monitor clinical care services provided to members related to mental health and substance abuse treatment to optimize clinical outcomes.. - Provide information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Aetna Behavioral Health policies and procedures, and criteria.. - Qualifying Behavioral Health degree (i.e. LPC, LPCC, LISW, LCSW).. - Utilization review, prior authorization, concurrent review, appeals experience preferred.. A minimum of a Master's Degree with a qualifying BH licensure (i.e. LPC, LPCC, LISW, LCSW)

clinical case manager

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Position Summary
This is a full time remote field based position in the Southwest Region of Virginia. Qualified candidates must reside in the Southwest region. The schedule is Monday-Friday, standard business hours. Must possess reliable transportation and be willing and able to travel in the assigned region 25-40% of the time. Mileage is reimbursed per our company expense reimbursement policy.
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. - Monitor clinical care services provided to members related to mental health and substance abuse treatment to optimize clinical outcomes.
- Provide telephone triage and crisis intervention.
- Provide information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Aetna Behavioral Health policies and procedures, and criteria.
- Interact with Supervisors to discuss clinical questions and concerns regarding specific cases.
- Participate in QI activities including data collection, tracking, and analysis. Telephonic clinical case management.
- Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs.
- Completes a Comprehensive Assessment and Plan of care.
- Will document in clinical systems.
- Active participation in clinical treatment rounds.
- Active participation in team activities focused on program development. Innovative thinking expected. Required Qualifications
- 3+ years of direct clinical practice experience post degree e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.
- Qualifying Behavioral Health degree (i.e. LPC, LPCC, LISW, LCSW).
- 2+ years of behavioral health experience required. Preferred Qualifications
- 2+ years of managed care experience highly preferred.
- 2+ years of case management experience preferred.
- Experience with youths in foster care system or adoption assistance preferred.
- Discharge planning experience preferred.
- Utilization review, prior authorization, concurrent review, appeals experience preferred.
- Advanced crisis intervention skills preferred.
- CCM preferred. Education
A minimum of a Master's Degree with a qualifying BH licensure (i.e. LPC, LPCC, LISW, LCSW)
Pay Range
The typical pay range for this role is:
$60,522.80 - $129,600.00 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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution. #J-18808-Ljbffr

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