Case Manager Behavioral Health - LCSW or LCPC (Field - Chinatown area)

CVS Health•Oak Park, IL

4d•$66,575 - $142,576

About The Position

CVS Health’s Aetna team is seeking a Behavioral Health Case Manager to support members enrolled in Medicare and Medicaid who have complex health and social challenges. The role uses a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy to address members’ comprehensive health needs and promote quality, cost-effective outcomes. The position is field-based in the South Loop, Chinatown, and surrounding areas, with travel required for up to 50–75% of the time. The Case Manager assesses member needs and eligibility, develops approaches to resolve concerns, and coordinates care using clinical judgment, available benefits, and internal and external programs. The role includes crisis intervention and follow-up, application of clinical guidelines and regulatory standards, collaboration with supervisors and Medical Directors, and escalation of quality-of-care concerns. The Case Manager also supports member engagement and informed healthcare decision-making, develops and monitors plans of care with members and care teams, and documents services in compliance with company, regulatory, and accreditation requirements.

Requirements

Must reside in Illinois.
3–5 years of clinical practical experience.
2–3 years of case management, discharge planning, and/or home health care coordination experience.
Must possess reliable transportation and be willing and able to travel up to 50–75% in South Loop, Chinatown, and surrounding areas.
Ability to work independently and confidence working from home as an independent thinker while collaborating and connecting with teams virtually.
Excellent analytical and problem-solving skills.
Effective communication, organizational, and interpersonal skills.
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some proprietary applications.
Efficient computer skills, including navigating multiple systems and keyboarding.
Master’s degree in Behavioral/Mental Health or a related field.
LCSW or LCPC license in the state of Illinois.

Nice To Haves

Certified Case Manager.
Bilingual.

Responsibilities

Conduct comprehensive assessments of referred members’ needs and eligibility using clinical tools and information or data review.
Evaluate benefit plans and internal and external programs or services to determine approaches to case resolution and meeting members’ needs.
Apply clinical judgment and strategies to reduce risk factors and address complex clinical indicators affecting care planning.
Perform crisis intervention for members experiencing behavioral health or medical crises, refer them to appropriate providers, and provide crisis follow-up.
Apply or interpret applicable criteria, clinical guidelines, case management plans, policies, procedures, and regulatory standards when assessing benefits and member needs.
Consult with supervisors, Medical Directors, and other programs to address barriers to goals and present cases at case conferences for multidisciplinary input.
Identify and escalate quality-of-care issues through established channels.
Communicate with medical and behavioral health professionals to influence appropriate member care.
Use influencing and motivational interviewing skills to engage members and promote lifestyle or behavior changes.
Coach and support members so they can make independent medical and healthy lifestyle choices and participate knowledgeably in healthcare decisions.
Analyze utilization, self-reported, and clinical data to identify comprehensive member needs.
Develop and monitor plans of care with members and their care teams.
Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.