Clinical Case Manager- Behavioral Health -NJ

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.

This is a telework position and the care manager must work normal business hours of Monday - Friday 8:00am - 5:00pm EST; no weekends or holidays.

The Clinical Case Manager is responsible for conducting face to face visits in acute mental health facilities and PRTFs, members homes, and in the community.

Must have reliable transportation and be willing and able to travel up to 25 - 50% of the time within NJ as needed. Applicants must reside in New Jersey. Preference for those residing in North or South NJ counties (Union, Essex, Bergen, Passaic) and Southern Counties (Cape May, Cumberland, Atlantic).

Position Summary

Applies advanced clinical judgement to facilitate appropriate member physical health and behavioral healthcare. Implements strategy to assess and plan care, direct provider collaboration, and coordinate psychosocial wraparound services. Instructs the application of available resources to produce optimal, cost-effective outcomes.

The most rewarding aspect of the Clinical Care Management role is evidenced by the positive outcomes of collaborative efforts between the care manager, member, and servicing providers.

• Executes comprehensive assessments of member needs and eligibility by evaluating member benefit plans and available services.
• Develops strategies to reduce risk factors and address complex clinical indicators that impact care planning and issue resolution.
• Acts as a top-level specialist to perform crisis intervention with members experiencing a behavioral health or medical crisis, refers appropriate providers, and follows up to ensure members are receiving the appropriate services.
• Adapts clinical guidelines, standardized case management procedures, and regulatory standards to needs assessments to ensure appropriate administration of benefits.
• Counsels with medial and behavioral health professionals to influence appropriate member care.
• Coaches members to make ongoing independent medical and healthy lifestyle choices, and to actively participate with providers in healthcare decision-making.
• Coaches and trains junior colleagues in techniques, processes, and responsibilities.
• Responsible to coordinate and collaborate care with member/authorized representative, PCP, and any other care team participant
• Attend interdisciplinary meetings and advocate on members behalf
• Work with the member and care team to coordinate and assist with community resources
• Documenting accurately and timely in the electronic health record
• Use critical thinking and be able to problem solve any issues related to assigned membership

Required Qualifications
A Brief Overview
Applies advanced clinical judgement to facilitate appropriate member physical health and behavioral healthcare. Implements strategy to assess and plan care, direct provider collaboration, and coordinate psychosocial wraparound services. Instructs the application of available resources to produce optimal, cost-effective outcomes.

What you will do

• Executes comprehensive assessments of member needs and eligibility by evaluating member benefit plans and available services.
• Develops strategies to reduce risk factors and address complex clinical indicators that impact care planning and issue resolution.
• Acts as a top-level specialist to perform crisis intervention with members experiencing a behavioral health or medical crisis, refers appropriate providers, and follows up to ensure members are receiving the appropriate services.
• Adapts clinical guidelines, standardized case management procedures, and regulatory standards to needs assessments to ensure appropriate administration of benefits.
• Counsels with medial and behavioral health professionals to influence appropriate member care.
• Coaches members to make ongoing independent medical and healthy lifestyle choices, and to actively participate with providers in healthcare decision-making.
• Coaches and trains junior colleagues in techniques, processes, and responsibilities.