Clinical Case Manager, Behavioral Health - Field-MI (Wayne and Macomb County)
About The Position
The Clinical Case Manager, Behavioral Health coordinates care for members with long-term rehabilitation or psychosocial needs related to birth defects, chronic conditions, illness, or injury. The role works to prevent exacerbations, readmissions, and placement in custodial care. It implements and coordinates case management, psychosocial, and quality-of-life activities across the continuum of care, including consultant referrals, home care visits, community resources, and alternative levels of care. The position develops strategies to coordinate acute and long-term care services for members receiving case or disease management, and provides psychosocial interventions through resource identification, program development, and other means. It may specialize in a disease area and provide consultation to other health care professionals. This work-at-home role covers Wayne and Macomb Counties and involves 25–50% travel. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. ET.
Requirements
- Minimum experience in medical social work or case management; the number of years is not specified.
- Comply with all state requirements in the state where job duties are performed.
- Be willing and able to travel 25%–50% in Wayne and Macomb Counties; reliable transportation is required. Mileage is reimbursed under the company expense reimbursement policy.
- Basic awareness of problem-solving and decision-making skills.
- Basic awareness of digital literacy skills.
- Basic knowledge of medical terminology.
- Ability to deal tactfully with customers and community members.
- Ability to handle sensitive information ethically and responsibly.
- Ability to evaluate relative costs and benefits of potential actions and choose an appropriate option.
- Ability to function in a clinical setting with diverse cultural dynamics among clinical staff and patients.
- Master’s Degree in Social Work, as required by state law.
- LMSW.
Nice To Haves
- Behavioral health experience.
- Bilingual in Spanish or Arabic.
Responsibilities
- Manage members with acute or chronic conditions, focusing on quality of care, compliance, outcomes, and cost reduction.
- Conduct initial and periodic assessments of members enrolled in Long-Term Care, case management, or disease management programs to determine an appropriate course of treatment.
- Develop individualized case plans for members at risk of poor outcomes, applying case management concepts, principles, and strategies.
- Communicate updates and facilitate discussions about patient status with providers, primary care physicians, Medical Directors, pharmacists, and care management staff, internally and externally.
- Identify opportunities for members to receive care covered by their benefit plans in home or community settings.
- Provide information, resources, and education about social issues, mental health, and available services.
- Develop programs to reduce acute and chronic member admissions, increase community integration, and improve health outcomes.
- Coach junior colleagues in social work techniques, processes, and responsibilities.
- Collaborate with community members, organizations, and policymakers to create opportunities for clients, address community issues, and raise awareness.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
- Eligible for a CVS Health bonus, commission, or short-term incentive program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
