[Hiring] Clinical Case Manager @CVS Health

Role Description

Functions as a coordinator of care for members identified as having long-term rehabilitation and/or psychosocial needs because of birth defects, chronic conditions, illness or injury for members to prevent exacerbations, re-admissions or need for placement into custodial care. Responsible for implementing and coordinating all case management, psychosocial, and quality of life activities relating to cases across the continuum of care including consultant referrals, home care visits, use of community resources and alternative levels of care. Responsible for developing and carrying out strategies to coordinate and integrate all acute and long-term care services to the members, and to those in case and disease management. Provides psychosocial interventions through resource identification, program development and other means. This position may specialize within a disease area and may serve in a consultative role to other health care professionals.

Help us elevate our patient care to a whole new level!

• Controls comprehensive management of members with acute or chronic conditions, including case management activities that focus on quality of care, compliance, outcomes and decreasing costs for individuals and communities.
• Implements initial and periodic assessments of the members enrolled in the Long-Term Care Program and/or case or disease management programs under limited supervision to determine course of treatment.
• Applies in-depth knowledge of case management concepts, principles, and strategies in the development of an individualized case plan for enrolled members in case or disease management that are at risk of poor outcomes.
• Communicates updates and facilitates discussion with providers, primary care physicians, Medical Directors, pharmacists, and care management staff regarding the status of patients internally and externally.
• Identifies opportunities to ensure the member receives all the necessary care allowed under the member’s benefit plan in home or community settings.
• Provides information, resources, and education on social issues, mental health, and available services to raise awareness and empower individuals and communities.
• Develops complex, innovative programs designed to reduce admissions for acute and chronic members, increase community integration, and improve health outcomes for enrolled patients and outside individuals.
• Coaches more junior colleagues in techniques, processes, and responsibilities of social work to improve capacity.
• Collaborates with community members, organizations, and policymakers to create opportunities for clients, address community issues, or raise awareness for specific issues.

Qualifications

• Minimum years experience in medical social work or case management.
• Complies with all state requirements in the state where job duties are performed.
• Must be willing and able to travel up to 25%- 50% of the time in Wayne and Macomb Counties. Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy.
• Basic awareness of problem solving and decision making skills.
• Basic awareness of digital literacy skills.
• Basic knowledge of medical terminology.
• Ability to deal tactfully with customers and community.
• Ability to handle sensitive information ethically and responsibly.
• Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option.
• Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients.

Preferred Qualifications

• Behavioral health experience.
• Bilingual in Spanish or Arabic.

Educational/Licensure Requirements

• Master’s Degree in Social Work as required by state law.
• LMSW.

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.

Pay Range

The typical pay range for this role is: $60,522.00 - $129,615.00. 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.