CVS Health-posted 26 days ago
Full-time • Mid Level
Remote • Sparks, NV
5,001-10,000 employees
Ambulatory Health Care Services

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryUtilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Telephonic clinical case management with Medicare population.Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs. Completes a Comprehensive Assessment and Plan of care.Will document in clinical systems to support legacy Aetna and Coventry membership.Provides BH consultation and collaboration with Aetna partners.Active participation in clinical treatment rounds.Active participation in team activities focused on program development. Innovative thinking expected.The majority of time is spent at a desk on telephonic member outreaches and computer documentation.Assist members with locating community based behavioral health resources.

  • Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning
  • Direct provider coordination/collaboration
  • Coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes
  • Telephonic clinical case management with Medicare population
  • Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs
  • Completes a Comprehensive Assessment and Plan of care
  • Will document in clinical systems to support legacy Aetna and Coventry membership
  • Provides BH consultation and collaboration with Aetna partners
  • Active participation in clinical treatment rounds
  • Active participation in team activities focused on program development
  • Assist members with locating community based behavioral health resources
  • 3+ years of direct clinical practice experience
  • An active and unrestricted clinical behavioral health license in state of residence is required (ex: LPC, LCSW, LMFT, LPCC, LISW, LSW)
  • Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps in order to ensure sufficient speed to adequately perform work duties.
  • Crisis intervention skills preferred
  • Managed care/utilization review experience preferred
  • Case management and discharge planning experience preferred
  • Discharge planning experience
  • Utilization review, prior authorization, concurrent review, appeals experience
  • CCM preferred
  • DSNP experience a plus
  • Knowledge of Substance Abuse Disorders
  • Bilingual Spanish and English
  • 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.
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