Behavioral Health Clinical Case Manager
CVS Health
full-time
Posted on:
Location Type: Hybrid
Location: Lexington • Kentucky • United States
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Salary
💰 $54,095 - $116,760 per year
About the role
- 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 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.
- 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.
- In collaboration with the member and their care team, develops and monitors established plans of care to meet the member’s goals.
Requirements
- 3-5 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.
- Minimum of 1 year experience clinically serving system-engaged youth and families, including those involved with: Department of Juvenile Justice (DJJ), Department for Community Based Services (DCBS), or other child-serving systems supporting youth with complex behavioral, legal, or social services involvement.
- Crisis intervention skills preferred.
- Managed care/utilization review experience preferred.
- Case management and discharge planning experience preferred.
- Minimum of a Master's degree in Behavioral/Mental Health or related field.
- Unencumbered Behavioral Health clinical license in Kentucky (LCSW, LPCC, LMFT).
Benefits
- Affordable medical plan options
- 401(k) plan (including matching company contributions)
- Employee stock purchase plan
- No-cost programs for all 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 access and many other benefits depending on eligibility.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
crisis interventioncase managementdischarge planningclinical assessmentbehavioral healthcareutilization reviewcare planningmotivational interviewingdata analysisholistic approach
Soft Skills
clinical judgmentcritical thinkingcommunicationinfluencingcoachingcollaborationproblem-solvingmember engagementempowermentteamwork
Certifications
Master's degree in Behavioral/Mental HealthLCSWLPCCLMFT