Clinical Case Manager Behavioral Health -Field

CVS Health • Chalmers, IL

8d • 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 This is telework position with up to 50-75% travel in designated region of Illinois. Standard working hours can be anywhere within 8am - 9pm as needed to meet business needs. This Care Manager BH role requires working until 9pm for two (2) days a week. Care Manager BH coordinates all case management activities with members to evaluate medical needs and to facilitate the overall wellness of members. Develops strategy to address issues to outcomes and opportunities to enhance member's overall wellness through integration. Instructs programs and procedures in compliance with network management and clinical coverage policies.

Requirements

• Clinical licensure
• Minimum two years experience working with children living with special needs or children in foster care
• Willing and able to travel up to 50-75% of their time to meet members face to face within one hour of their location
• Reliable transportation required; mileage is reimbursed per company expense reimbursement policy
• Willing and able to work until 9:00pm two (2) days a week

Nice To Haves

• Managed Care experience
• Case Management experience

Responsibilities

• Executes evaluation of member needs and benefit plan eligibility and facilitates member transition to the organization's programs and plans
• Applies advanced clinical judgement to incorporate strategies designed to reduce risk factors and barriers, and to address complex health indicators that impact care planning and resolution of member issues.
• Handles reviews of prior claims to address potential impact on current case management and eligibility.
• Creates a holistic approach to assess the need for referrals to clinical resources and to assist in determining functionality.
• Ensures case management processes follow organization and regulatory requirements.
• Implements systems to maximize member engagement, discern health status and needs, and to assess member levels of work capacity and restrictions.
• Coaches and trains junior colleagues in techniques, processes, and responsibilities.
• Primarily works with members enrolled into Pathways to Success Program for intensive care coordination support.

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