Clinical Case Manager Behavioral Health

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.

• What you will do
  • Coordinates behavioral health assessments to gain information on substance abuse history and mental health; determines the most appropriate social support system for patient health.
  • Develops a complex resource coordination system to assists with outpatient counseling, support groups, housing assistance, vocational rehabilitation, or medication management.
  • Documents individualized treatment plans based on assessments; develops plans which include goals, interventions, and measurable outcomes.
  • Configures electronic medical software to categorize behavioral health conditions by severity.
  • Edits content for the clinical advocacy campaign to deliver an impactful message surrounding client rights and health needs.
  • Examines the data management system to ensure compliance with data privacy and security regulations.
  • Identifies opportunities to develop training programs for the clinical case manager to ensure a thorough understanding of behavioral health practices.
  • implements a monitoring and evaluation system to monitor patient progress towards goals.
  • Installs an electronic medical record to monitor the input and output of the clinical case department.
  
  For this role you will need Minimum Requirements
  • Less than 5 years work experience
  • Working knowledge of problem solving and decision making skills.
  • Working knowledge of medical terminology.
  • Working knowledge of digital literacy skills.
  • Ability to deal tactfully with customers and community.
  • Ability to handle sensitive information ethically and responsibly.
  • Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option.
  • Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients.
  
  Preferred Qualifications
  • Certified Case Manager (ACM) preferred.
  
  Education
  • Bachelor's degree preferred/specialized training/relevant professional qualification.
• Requisition Job DescriptionRequisition Job Description

  ***Fully remote***

  Standard business hours.

  1 late day until 7pm your local time.

  No holidays.

  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.

   

  Assessment of Members: Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member’s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.

  • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.

  • Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow-up to members to help ensure they are receiving the appropriate treatment/services. Enhancement of Medical Appropriateness and Quality of Care:

  • Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits

  • Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes

  • Identifies and