Clinical Case Manager Behavioral Health - Field - Must reside in Essex County NJ

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Position Summary:

The Clinical Case Manager – Behavioral Health is responsible for conducting in-person, comprehensive assessments for members enrolled in the Managed Long-Term Services and Supports (MLTSS) program and/or Dual Special Needs Program (D-SNP/FIDE). This role may also include evaluating non-MLTSS members to determine medical and support needs, facilitating access to services that promote overall wellness and independence.

Key Responsibilities:

• Conduct face-to-face assessments to evaluate member needs and eligibility for services such as adult/pediatric medical daycare, personal care assistance, nursing facility custodial care, the Personal Preference Program, and MLTSS enrollment.
• Collaborate with members, authorized representatives, primary care providers, and interdisciplinary care teams to develop and implement individualized care plans.
• Authorize services within the MLTSS/FIDE benefit structure and coordinate access to community-based resources.
• Participate in interdisciplinary team meetings and advocate on behalf of members to ensure appropriate care and support.
• Accurately and promptly document all assessments, care plans, and communications in the electronic health record system.
• Apply critical thinking and problem-solving skills to address member needs and resolve care-related issues.
• Mentor new hires upon achieving proficiency in the role.
• Maintain compliance with all regulatory and organizational requirements, including successful completion of the NJ Choice Certification (required for continued employment).

Work Environment & Travel:

• This is a telework position requiring availability during standard business hours of Monday -Friday 8-5 EST.
• Travel is required 50–75% of the time within Essex County and surrounding areas.

Required Qualifications:

• Must reside in Essex County
• Licensed Clinical Social Worker or Licensed Social Worker in NJ
• 2+ years Behavioral Health experience/expertise
• Strong clinical assessment, communication, and documentation skills.
• Ability to work independently while collaborating effectively with a multidisciplinary team.
• Commitment to delivering person-centered, culturally competent care.
• Must possess reliable transportation and be willing and able to travel up to 75% of the time. Mileage is reimbursed per our company expense reimbursement policy
• Successful completion of the NJ Choice certification is a contingency of employment. As per NJ Division of Aging Services, Office of Community Choice Options guidance, an exam score of 80% or higher is required, along with successful completion of the State training modules, and field mentoring component.

Preferred Qualifications

• Case management and/or discharge planning experience
• Managed Care experience
• Crisis intervention skills
• Proficiency using computers, keyboards and multi-system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams, etc.)

Education

• Master's Degree in Social Work or Behavioral Health field required

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$72,627.00 - $155,538.00

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. 
 

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