Clinical Case Manager - Behavioral Health - Field in Bergen, Hudson and Middlesex Counties, 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.

Job description: 

Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members. Health service strategies, policies, and programs are comprised of utilization management, quality management, network management, clinical coverage and policies. The position requires advanced clinical judgment and critical thinking skills in order to facilitate appropriate physical, behavioral health, psychosocial wrap around services. The care manager will be responsible for, care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner. Strong assessment, writing and communication skills are required.

Fundamental Components/Job Description:

The Clinical Case Manager BH is responsible for conducting face to face visits using comprehensive assessments of members enrolled in Managed Long-Term Services and Supports program (MLTSS) and/or Dual Special Needs Program (D-SNP/ FIDE). Care manager may also be responsible for face to face assessments with non-MLTSS members to evaluate the medical needs of the member to facilitate the member’s overall wellness and help them obtain the services they need to thrive by addressing requests for services such as adult medical daycare, pediatric medical daycare, personal care assistant, nursing facility custodial requests, personal preference program and MLTSS program enrollment. Successful completion of company sponsored NJ Choice Certification is requirement for continued employment. The care manager is responsible to coordinate and collaborate care with member/authorized representative, PCP, and any other care team participant. The care manager will attend interdisciplinary meetings and advocate on members behalf. The care manager works with member and care team to develop care plan and will authorize services within the MLTSS/ FIDE benefit. The care manager will also work with the member and care team to coordinate and assist with community resources. The care manager is responsible for documenting accurately and timely in the electronic health record. This position requires the care manager to use critical thinking and be able to problem solve any issues related to assigned membership. While this position is tele-work the care manager must work normal business hours.  The Case Manager will also be expected, to mentor new hires, once, a level of proficiency has been attained in their role. 50 to 75% travel in Middlesex and surrounding counties.

Required Qualifications

• Must reside in Bergen, Hudson and Middlesex County
• Must be Licensed Clinical Social Worker or Licensed Social Worker in NJ
• 2+ years Behavioral Health Exp
• 1+ years of proficiency with using computers and Microsoft Office.
• Successful completion (score of 80% or higher)of the NJ Choice certification is a contingency of employment.
• Must possess reliable transportation and be willing and able to travel up to 50-75% of the time. Mileage is reimbursed per our company expense reimbursement policy

Preferred Qualifications

• Case management and/or discharge planning experience
• Managed Care experience
• Crisis intervention skills
• LTSS experience
• 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

The hours listed below are the required availability for this role. Please only apply if you can meet these schedule requirements.

Shift Flexibility:

Monday: -

Tuesday: -

Wednesday: -

Thursday: -

Friday: -

Saturday: -

Sunday: -

Weekend Shift Frequency:

Language

Pay Range

The typical pay range for this role is:

$72,