CVS Health-posted 3 months ago
$72,627 - $155,538/Yr
Full-time • Mid Level
Fairfield, NJ
5,001-10,000 employees
Ambulatory Health Care Services

At CVS Health, 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 reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. The Clinical Case Manager is responsible for developing and executing health service strategies that promote high-quality, cost-effective care for members. This includes utilization management, quality improvement, network coordination, and adherence to clinical policies.

  • Conduct face-to-face assessments for members enrolled in Managed Long-Term Services and Supports (MLTSS) and/or Dual Special Needs Programs (D-SNP/FIDE).
  • Evaluate member needs and coordinate services such as medical daycare (adult/pediatric), personal care assistance, nursing facility placement, and MLTSS enrollment.
  • Collaborate with members, caregivers, providers, and interdisciplinary teams to create and implement individualized care plans.
  • Authorize services in accordance with program guidelines and connect members to appropriate community resources.
  • Accurately and promptly document all case management activities in the electronic health record.
  • Apply advanced clinical judgment and critical thinking to resolve complex care issues.
  • Mentor new hires once proficient in the role.
  • Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW).
  • Minimum of 2 years of behavioral health experience.
  • Strong assessment, communication, and documentation skills.
  • Successful completion of NJ Choice Certification (minimum score of 80% required for continued employment).
  • Ability to work independently in a remote environment during standard business hours.
  • Reliable transportation and willingness to travel up to 75% of the time (mileage reimbursed per company policy).
  • Flexibility to occasionally cover Cumberland County, NJ.
  • Experience in case management and/or discharge planning.
  • Background in managed care.
  • Crisis intervention skills.
  • 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.
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