Clinical Case Manager Behavioral Health

At reputed company, we?re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation?s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues ? caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary: Fully remote role in the USA. Schedule Monday-Friday; standard business hours No nights, no weekends, and no holidays Utilizes reputed company judgment and critical thinking skills to facilitate appropriate member physical health and behavioral reputed company through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and reputed company, cost-effective reputed company. 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 reputed company clinical indicators which reputed company planning and resolution of member issues. -Using reputed company skills, performs crisis reputed company 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 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 reputed company reputed company reputed company -Identifies and escalates quality of care issues through established channels -Ability to reputed company 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 reputed company reputed company level of health -Provides coaching, information and support to reputed company the member to reputed company ongoing independent medical and/or healthy lifestyle choices. -Helps member actively and knowledgably participate with their provider in reputed company decision-making -Analyzes reputed company utilization, self-report and clinical data available to consolidate information and reputed company 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. --Ability to take and manage crisis calls. Required Qualification: -3+ years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility -3+ years minimum of Behavioral Health experience -Unencumbered & active Independent Behavioral Health clinical license in the state where they work one of the following: -Licensed Mental Health Counselor (LMHC) -Licensed Clinical reputed company Worker (LCSW) -Licensed Independent reputed company Worker (LISW) -Licensed Marital and Family Therapist (LMFT) -Licensed Professional Counselor (LPC) Preferred qualifications: -Ability to take and manage crisis calls -Managed care/utilization review experience preferred -Case management and discharge planning experience preferred Education: Minimum of a Master's degree in Behavioral/Mental Health or reputed company field Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $54,095.00 - $116,760.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay reputed company listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits ? investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: ? Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. ? No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. ? Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 04/30/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job!