Clinical Case Manager Behavioral Health

Company: CVS Pharmacy
Location: High Point
Posted on: November 17, 2023

Job Description:

Job DescriptionSchedule is Monday-Friday 8am - 5pm. One late day/night a week. No weekends and no holidays.This is fully telework role. Anywhere in Continental US.Potential for rare travel for meetings.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 and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/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 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 to help ensure they are receiving the appropriate treatment/services.Enhancement of Medical Appropriateness and Quality of Care: 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 in order 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 influencing/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.Monitoring, Evaluation and Documentation of Care: 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. Must be able to multitaskPay RangeThe typical pay range for this role is:Minimum: 55,300Maximum: 118,900Please 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 Masters prepared behavioral health clinician with unrestricted Independent Behavioral Health licenses in the state where they work (ex: 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 2+ years of experience using Motivational Interviewing requiredCOVID RequirementsCOVID-19 Vaccination RequirementCVS 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- Crisis Intervention skills preferred - Managed care/utilization review experience preferred; case management and discharge planning experienceEducationEducation Master's degree Clinical licensure required per aboveBusiness OverviewBring your heart to CVS HealthEvery 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.

Keywords: CVS Pharmacy, High Point , Clinical Case Manager Behavioral Health, Executive , High Point, North Carolina