Clinical Case Manager - Behavioral Health Clinical Liaison (LCSW or LCPC)

CVS Health

3d • Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The remote Behavioral Health Clinical Liaison is a clinical leader in the duals plan focused on integrating member care and clinical coordination, leading the development, implementation and ongoing monitoring of program and quality initiatives to address the needs of Aetna Better Health Premier Plan MMAI (Illinois). Fundamental Components The BH Clinical Liaison represents the plan and collaborates with state government, key stakeholders, community organizations, advocacy groups as well as plan leadership to enhance the quality of services provided to members and to ensure adherence to performance targets of the business area.

Requirements

• 5+ years advanced clinical management experience in behavioral health
• Candidate must have active and unrestricted Licensed Clinical Social Worker (LCSW) or Licensed Clinical Professional Counselor (LCPC) in state of residence

Nice To Haves

• Certified Alcohol and Drug Counselor (CADC) certification
• 2+ years of experience working for a managed care organization

Responsibilities

• Serves as a Behavioral Health (BH) and Substance Use Disorder (SUD) subject matter expert and key resource regarding any issues relating to integration of member care across departments.
• Displays comprehensive understanding of Bio-Psycho-Social principles and practices as they apply across all domains of health care. This includes the ability to apply BH and SUD knowledge, skills, tools and resources to effectively impact three potential areas of opportunity: Physical Health and Behavioral Health co-morbidity: co-occurrence of mental disorders and/or substance use disorders when physical health disorders are named as the primary diagnosis Psychosocial complexity that creates barriers to member/family engagement with, participation in and adherence to effective health practices Difficult relationships between members/families and their health care providers on the one hand, and/or with their care managers on the other, that undermine their ability to collaborate to manage complex, recurring, enduring and disabling health conditions
• Possesses fundamental knowledge of principles of substance use disorder and addiction medicine including ASAM levels of care. This includes ability to communicate with members based on a medical understanding of substance use disorders in a manner that is respectful, non-judgmental, non-stigmatizing, and encouraging. Motivational interviewing skills are a plus.
• Drives collaboration on quality of care, utilization management, disparities, and care coordination to ensure optimal member outcomes.
• Consults with management regarding physical and behavioral health clinical issues as they relate to medical management (utilization management, care management, quality management) provider and system of care issues, BH and social services system issues including critical stakeholders of various departments.
• Represents the plan to relevant external stake holders, such as providers/vendors and advocacy groups regarding quality improvement initiatives, integrating member care, health plan success and innovative care strategies.
• Engages members with complex clinical presentations, identifies opportunities for improving rounds and provides input to clinical leadership team to optimize.
• Supports the plan’s ability to comply with Behavioral Health and Substance Use outcomes required by regulators and credentialing bodies (i.e., CMS, ODM, NCQA).
• Advises on care coordination needs for members during and after inpatient behavioral health and substance use disorder admissions.
• This position requires an individual who is an effective leader as well as organized, individually motivated, and accountable.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level