Clinical Case Manager, Behavioral Health (West Valley, Arizona)

CVS Health•Work At Home-Arizona, AZ

5d•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. Mercy Care is a not-for-profit Medicaid managed-care health plan, serving Arizonans since 1985. We provide access to physical and behavioral health care services, specifically to people who are eligible for Medicaid. Our members include families, children, seniors, and individuals who have developmental/cognitive disabilities. We hold multiple contracts with AHCCCS, Arizona’s Medicaid agency, and deliver services throughout the state. Mercy Care is administered by Aetna, a CVS Health company. Our staff is employed by Aetna and CVS Health. This gives Mercy Care the resources of a national organization, and still allows us to bring our members the familiarity and presence of a local team of people who put our members at the center of everything we do.

Requirements

Active and good standing Arizona clinical and/or counseling license, specifically LPC (Licensed Professional Counselor), LAC (Licensed Associate Counselor), LMSW (Licensed Master Social Worker), LCSW (Licensed Clinical Social Worker), and/or LISAC (Licensed Independent Substance Abuse Counselor).
3+ years of direct clinical practice experience.
2+ years of case management experience, specifically working with people who have been designated as having a serious mental illness (SMI), are elderly, or have a physical disability.
Must reside in West Valley, Maricopa County, Arizona.
Willingness to work Monday-Friday from 8am-5pm Arizona Time Zone.
Must possess reliable transportation and be willing and able to travel up to 25-50% of the time within West Valley, Arizona, specifically to meet with members.

Nice To Haves

Proficient in Microsoft Suite, including Word, Excel, PowerPoint, Outlook, and Teams.
Strong time management skills, organizational skill set, and ability to multitask.
Strong customer service skills.
Excellent communication skills, both verbal and written.
Ability to quickly learn several operating systems for data entry and authorizations.
Previous experience collaborating with medical professionals.
Strong team player.
Crisis intervention skills.
Previous experience with managed care and utilization review.
Previous experience with discharge planning.

Responsibilities

Utilize clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
Apply critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for members, specifically by providing care coordination, support, and member education through the use of care management tools and resources.
Conduct comprehensive evaluation of referred member’s needs/eligibility and recommend an approach to case resolution and/or meeting needs, particularly by evaluating member’s benefit plan, as well as available internal and external programs/services.
Identify high-risk factors and service needs that may impact member outcomes and care planning components with appropriate referrals.
Coordinate and implement assigned care plan activities and monitor care plan progress.
Use a holistic approach to overcome barriers to meet goals and objectives; present cases at case conferences to obtain multidisciplinary review, in order to achieve optimal outcomes.
Identify and escalate quality of care issues through established channels.
Utilize negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes, in order to achieve optimum level of health.
Provide coaching, information, and support to empower the member to make ongoing, independent medical and/or healthy lifestyle choices.
Help members actively and knowledgably participate with their provider in healthcare decision-making.
Utilize case management processes in compliance with regulatory and accreditation guidelines, as well as company policies and procedures.