Clinical Case Manager Behavioral Health - TOC

CVS Health•Mentor, KY

1d•$60,522 - $129,615•Hybrid

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. Utilizes advanced clinical expertise, critical thinking, and behavioral health knowledge to provide consultation, coaching, and support to healthcare professionals, care coordination teams, and community partners serving complex behavioral health populations. Facilitates collaboration among providers, hospitals, care management teams, and community stakeholders to promote quality care delivery, appropriate resource utilization, successful transitions of care, and adherence to clinical and organizational standards. Functions as a clinical liaison and subject matter expert, supporting care teams through education, case consultation, problem-solving, and relationship management. This position operates in a hybrid work environment, including both remote work and regular onsite presence at a designated behavioral health hospital.

Requirements

Master's degree in Behavioral Health, Mental Health, Social Work, Counseling, Psychology, or a related field.
Current, unrestricted behavioral health licensure in the State of Ohio (e.g., LSW, LPC, MFT, or equivalent).

Nice To Haves

3–5 years of post-master's clinical experience in behavioral health, preferably in inpatient psychiatric, hospital-based, care management, care coordination, or community behavioral health settings.
Experience providing consultation, coaching, education, or support to healthcare professionals preferred.
Experience working collaboratively with hospitals, behavioral health providers, managed care organizations, or multidisciplinary care teams preferred.
Knowledge of care transitions, discharge planning, crisis services, and community behavioral health resources preferred.
Managed care experience preferred.
Strong relationship-building, facilitation, and communication skills required.

Responsibilities

Serve as a clinical consultant and subject matter expert for hospital staff, care coordinators, and community-based professionals supporting members with complex behavioral health needs.
Provides coaching, guidance, and education related to behavioral health best practices, care coordination processes, discharge planning, community resources, and care transitions.
Collaborates with hospital treatment teams, care management staff, providers, and community partners to identify and address barriers impacting successful care coordination and discharge planning.
Supports multidisciplinary teams through case consultation, clinical problem-solving, and recommendations designed to improve care outcomes and continuity of care.
Facilitates communication and collaboration between healthcare providers, health plan teams, and community organizations to promote integrated care delivery.
Utilizes clinical expertise to review complex behavioral health cases, identify potential gaps in care, and recommend appropriate interventions, resources, or escalation pathways.
Assists care teams in understanding and applying clinical guidelines, regulatory requirements, organizational policies, and established care management practices.
Provides education and support regarding available behavioral health services, community resources, and care coordination tools.
Identifies trends, barriers, and system-level opportunities impacting member care and communicates findings to leadership and operational partners.
Develops and maintains collaborative relationships with hospital leadership, clinical teams, community providers, and internal stakeholders.
Participates in interdisciplinary meetings, case conferences, and care coordination discussions to support quality outcomes and effective service delivery.
Supports quality improvement initiatives, process enhancement efforts, and organizational goals related to behavioral health care coordination and transitions of care.
Identifies and escalates quality-of-care concerns through established organizational channels.
Maintains accurate documentation and reporting in accordance with organizational, regulatory, and accreditation requirements.
Represents the organization as a clinical liaison within designated behavioral health facilities