Clinical Case Manager BH

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Position Summary

BH Position Summary:

As a Clinical Case Manager you will utilize advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare. You will complete comprehensive assessments to create a care plan. You will collaborate directly with providers, and coordinate psycho-social wraparound services. Ultimately, promoting 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 a 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 escalates quality of care issues through established channels

- Ability to speak to medical and behavioral health

professionals to influence appropriate member care.

- Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health

- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

- Helps member actively and knowledgeably participate with their provider in healthcare decision-making

- Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.

Monitoring, Evaluation and Documentation of Care:

- In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals

- Utilizes case management and quality management processes in compliance with

regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

- 2+ years of supervised clinical experience in a human services field
- 1+ year experience working with adults with behavioral health needs
- Current/Active unrestricted Clinical BH licensure (LCSW or LCPC) in the state of IL
- Willing and able to travel up to 50% of their time to meet members face to face (mostly in the hospitals setting) with in the Chicagoland area.

Preferred Qualifications

Previous Care Coordination experience

- Managed Care experience

Education:

Minimum of a master's degree in behavioral/Mental Health or human services field.

Pay Range

The typical pay range for this role is:

$29.50 - $63.75

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,