[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 position in Louisiana. In-state travel is required to conduct face-to-face visits and in-person outreach. This position is part of the ABH- Louisiana Children’s Specialty Foster Care program.

Schedule is Monday – Friday, 8am-5pm, standard business hours. No nights, weekends, and no 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

• 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 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 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
• 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 multitask, prioritize and effectively adapt to a fast-paced changing environment
• Effective communication skills, both verbal and written

Benefits

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