Clinical Case Manager Behavioral Health - Work at Home - NY

CVS Health•New York, NY

2d•$66,575 - $142,576•Remote

About The Position

The Behavioral Health Care Manager is responsible for coordinating, assessing, planning, and managing services for members with behavioral health, medical, and psychosocial needs. This role focuses on supporting individuals with serious mental illness (SMI), substance use disorders (SUD), co-occurring behavioral and physical health conditions, and complex social determinants of health. The Care Manager collaborates with members, caregivers, providers, and community resources to develop person-centered care plans that promote recovery, independence, safety, and improved health outcomes. The Behavioral Health Care Manager serves as an advocate for members and ensures appropriate access to behavioral health, medical, long-term care, and community-based services while maintaining compliance with Medicaid, Medicare, and regulatory requirements.

Requirements

Must be licensed in NY as LMSW or LCSW.
Work schedule is Mon - Fri 08:30-05:00 PM EST
Minimum of 3 years of experience in behavioral health, care management, case management, social work, managed care, health home, or related healthcare setting.
Experience working with adults with serious mental illness, substance use disorders, and co-occurring behavioral and physical health conditions.
Experience working with Medicaid and/or Medicare populations required.
Experience coordinating services across behavioral health, medical, long-term care, and community-based settings
Master's Degree in Social Work (MSW) from an accredited institution required.
Current New York State Licensed Master Social Worker (LMSW) required.
Strong understanding of behavioral health diagnoses, treatment modalities, and recovery principles.
Knowledge of Medicaid, Medicare, Managed Care, and behavioral health regulations.
Knowledge of serious mental illness, substance use disorders, crisis intervention, and trauma-informed care.
Excellent assessment, care coordination, and care planning skills.
Strong clinical judgment and critical-thinking abilities.
Ability to effectively engage members with complex psychosocial and behavioral health needs.
Excellent communication, motivational interviewing, and relationship-building skills.
Ability to work independently and manage a high-volume caseload.
Proficiency with electronic medical records and care management platforms.
Strong organizational skills and attention to detail.

Nice To Haves

Clinical licensure (LCSW) strongly preferred.
Experience in Managed Medicaid, Medicare Advantage, Dual Eligible populations, MLTC, Health Home, or Integrated Care programs.
Knowledge of HCBS, supportive housing, community mental health resources, and long-term services and supports (LTSS).
Case Management Certification (CCM, ACM, or equivalent).
Bilingual skills preferred English/Spanish

Responsibilities

Conduct comprehensive psychosocial, behavioral health, and care management assessments.
Develop, implement, monitor, and update individualized care plans based on member goals, needs, and preferences.
Coordinate behavioral health, medical, pharmacy, and social support services across multiple providers and settings.
Identify and address barriers to care, including housing instability, food insecurity, transportation needs, and lack of social support.
Facilitate referrals and linkage to community resources, behavioral health services, HCBS programs, and supportive services.
Monitor member progress through regular outreach, care plan reviews, and interdisciplinary case discussions.
Coordinate transitions of care following hospitalizations, psychiatric admissions, skilled nursing facility stays, emergency department visits, and rehabilitation services.
Provide crisis intervention support and facilitate appropriate behavioral health referrals as needed.
Promote recovery-oriented, trauma-informed, and culturally competent care practices.
Collaborate with psychiatrists, therapists, primary care providers, care management teams, and community partners.
Educate members and caregivers regarding treatment plans, medication compliance, self-management, and available resources.
Identify gaps in care and implement interventions to improve member outcomes and quality metrics.
Participate in interdisciplinary team meetings, utilization reviews, and case conferences.
Maintain timely and accurate documentation in compliance with organizational, state, federal, Medicaid, Medicare, and accreditation requirements.
Ensure completion of required assessments, care plans, outreach activities, and regulatory documentation within established timeframes.
Manage a caseload of members with varying levels of behavioral and medical complexity.