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Requisition Job Description

Fully remote in USA.

Shift: Monday-Friday standard business hours.

No nights, no weekends, no holidays and no on call.

The Clinical Case Manager 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, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

• The telephonic clinical case manager applies clinical judgment and incorporates the strategies designed to reduce risk factors for readmission and addresses complex clinical indicators which impact care planning and resolution of member issues.

• Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs.

• Using clinical tools and information/data review, conducts comprehensive assessments of member’s needs and determines approach to case resolution and meeting needs by evaluating member’s benefit plan and available internal and external programs and services with intent of reducing readmissions

• Will document in healthcare clinical systems to support ACA Individual Family Plan population.

• Provides BH consultation and collaboration with Aetna partners and other Shared Services with active participation in Interdisciplinary Care Team case conferences.

• Active participation in team activities focused on program development. Innovative thinking expected.

• This is a telephonic remote position, that is member-facing role with primary responsibility that includes member outreaches and computer documentation.

• Assist members completing medication reconciliation, provider referrals for aftercare and locating community based behavioral health resources as well as locating resources for social determinants of health.

Required Qualifications

• 3+ years of direct clinical practice experience

  • Master's degree in behavioral health field with unrestricted license in state of residence (ex: LPC, LMFT, LCSW, LMHC, LCMHC, LICSW, LISW, Clinical Psychologist.) , or active RN with extensive behavioral health background (BSN preferred)

-Must be computer proficient with general knowledge of Microsoft Word, Excel, Teams, Outlook

• Confidence working at home/independent thinker, using tools to collaborate and connect with teams   virtually

Preferred Qualifications

• Crisis intervention skills

• Managed care or utilization review experience

• Case management and discharge planning experience

-Substance Use Disorder experience

Education

Master’s Degree in Social Work or Counseling required OR RN with 3 years of behavioral health experience

Additional Requirements

Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps to ensure sufficient speed to adequately perform work duties. Some candidates may be eligible for partial reimbursement of the cost of residential broadband service.

Pay Range

The typical pay range for this role is:

$60,522.80 - $136,600.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 04/09/2024

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.