Clinical Case Manager, Behavioral Health Specialist
4 weeks ago
CVS Health is seeking a skilled Clinical Case Manager to join our team. As a Clinical Case Manager, you will play a critical role in facilitating 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.
Key Responsibilities- Conduct comprehensive assessments of referred members' needs/eligibility and determine approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
- Apply 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.
- Perform crisis intervention with members experiencing behavioral health or medical crisis and refer them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated. Provide crisis follow-up to members to help ensure they are receiving the appropriate treatment/services.
- Enhance medical appropriateness and quality of care by applying and/or interpreting 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.
- Consult with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; present cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes.
- Identify and escalate quality of care issues through established channels.
- Ability to speak to medical and behavioral health professionals to influence appropriate member care.
- Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes 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 member actively and knowledgably participate with their provider in healthcare decision-making.
- Analyze all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
- Masters prepared behavioral health clinician with unrestricted Independent Behavioral Health licenses in the state where they work (LPC, LCSW, LISW, LMFT, LCMHC, PsyD).
- 3+ years of direct clinical practice experience post master's degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.
- 3+ years experience with mental health and/or substance abuse disorders.
- 3+ years Microsoft Suite experience (eg. Word, Excel).
- 3+ years using documentation systems.
- Crisis Intervention skills preferred.
- Managed care/utilization management experience preferred. Case Management and discharge planning experience preferred.
- Motivational Interviewing skills preferred.
CVS Health offers a comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, and Employee Stock Purchase Plan. Eligible employees may also participate in the Company's term life insurance plan 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.
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Springfield, Illinois, United States CVS Health Full timeJob SummaryClinical Case Manager, Behavioral HealthClinical Case Manager, Behavioral Health, is a key role at CVS Health, where we strive to deliver enhanced human-centric healthcare for a rapidly changing world. As a Clinical Case Manager, Behavioral Health, you will play a vital part in our mission to bring our heart to every moment of our patients'...
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Springfield, Illinois, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Clinical Case Manager to join our team. As a Clinical Case Manager, you will play a critical role in facilitating appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services.Key...
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