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Job Details

CVS Health

Clinical Case Manager Behavioral Health





Highland Park, Illinois, United States

Job Description
This is a telework position with 50-75% travel to meet members in Lake county and North of Cook County IL and surrounding areas.

Strongly prefers qualified candidate to be located in these areas.

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.
Assessment of Members: Through the use of clinical tools andinformation/data review, conducts comprehensive assessments of referredmember’s needs/eligibility and determines approach to case resolutionand/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. - Applies 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. - Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members tohelp ensure they are receiving the appropriate treatment/services.Enhancement of Medical Appropriateness and Quality of Care: - Applicationand/or interpretation of applicable criteria and clinical guidelines,standardized case management plans, policies, procedures, and regulatorystandards while assessing benefits and/or member’s needs to ensureappropriate administration of benefits - Using holistic approach consultswith supervisors, Medical Directors and/or other programs to overcomebarriers to meeting goals and objectives; presents cases at caseconferences to obtain multidisciplinary view in order to achieve optimaloutcomes - Identifies and escalates quality of care issues throughestablished channels -Ability to speak to medical and behavioral healthprofessionals to influence appropriate member care. - Utilizesinfluencing/motivational interviewing skills to ensure maximum memberengagement and promotes lifestyle/behavior changes to achieve optimumlevel of health -Provides coaching, information and support to empower themember to make ongoing independent medical and/or healthy lifestylechoices. -Helps member actively and knowledgably participate with theirprovider in healthcare decision-making -Analyzes all utilization, self-reportand clinical data available to consolidate information and begin to identifycomprehensive member needs. Monitoring, Evaluation and Documentationof Care: -In collaboration with the member and their care team developsand monitors established plans of care to meet the member’s goals -Utilizescase management and quality management processes in compliance withregulatory and accreditation guidelines and company policies andprocedures.

Pay Range
The typical pay range for this role is:
Minimum: 26.59
Maximum: 57.21

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
Minimum of 2 years of supervised clinical experience in a human services field required

- Current Active unrestricted licensure (LCSW or LCPC) in the state of IL required

- Willing and able to travel using your own vehicle 50-75% of the time to meet members face to face in Lake county and North of Cook County IL and surrounding areas.

COVID Requirements

COVID-19 Vaccination Requirement
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.

Preferred Qualifications
Previous Care Coordination experience preferred
- Experience working with adults with Behavioral Health and/or medical needs.
- Experience working in IMD/SMHRF preferred (Specialized Mental Health Rehabilitation Facilities and Institutes for Mental Disease)

Minimum of a Master's degree in Behavioral/Mental Health, Social Work or human services field.

Business Overview
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.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.