[Hiring] Clinical Case Manager @CVS Health

Role Description

The Clinical Case Manager Behavioral Health (CM-BH) utilizes advanced clinical judgement 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.

This position is a full-time telework role in Louisiana, requiring in-state travel for face-to-face visits and in-person outreach. It is part of the ABH- Louisiana Children’s Specialty Foster Care program. The schedule is Monday – Friday, 8am-5pm, with no nights, weekends, or holidays. A flexible work schedule may be available after 6 months of service and with demonstrated performance and attendance.

Qualifications

• Must reside in Louisiana
• Must have reliable transportation and the ability to travel in-state up to 50% of the time
• Unencumbered Independent Behavioral Health Clinical license in the state of Louisiana (e.g., LCSW, LPC, LMFT)
• 3+ years of direct clinical practice experience post master’s degree, with general youth or pediatrics population in a hospital setting, alternative care setting such as ambulatory care, residential, or outpatient clinic/facility
• 2+ years of experience with personal computers, keyboards and multi-system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint, etc.)

Requirements

• Assessment of Members:
  • Conduct comprehensive assessments of referred member's needs/eligibility.
  • Apply clinical judgment to reduce risk factors and address complex clinical indicators.
  • Perform crisis intervention with members experiencing a behavioral health or medical crisis.
  • Provide crisis follow-up to ensure appropriate treatment/services.
• Enhancement of Medical Appropriateness and Quality of Care:
  • Application and interpretation of applicable criteria and clinical guidelines.
  • Consult with supervisors and Medical Directors to overcome barriers.
  • Identify and escalate quality of care issues.
  • Utilize motivational interviewing skills for member engagement.
  • Provide coaching and support to empower members in healthcare decision-making.
• Monitoring, Evaluation and Documentation of Care:
  • Develop and monitor established plans of care with the member and their care team.
  • Utilize case management and quality management processes in compliance with guidelines.
  • Ability to multitask, prioritize, and adapt to a fast-paced environment.
  • Effective communication skills, both verbal and written.

Benefits

• Comprehensive benefits package designed to support physical, emotional, and financial well-being.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.