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.Position Summary: Clinical Case Manager - Behavioral Health
The Clinical Case Manager is responsible for developing and implementing health service strategies that ensure high-quality, cost-effective care for members. This includes utilization management, quality improvement, network coordination, and clinical policy adherence.
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Key responsibilities include:
- Conducting face-to-face assessments for members in the Managed Long-Term Services and Supports (MLTSS) and/or Dual Special Needs Program (D-SNP/FIDE).
- Evaluating member needs and coordinating services such as adult/pediatric medical daycare, personal care assistance, nursing facility placement, and MLTSS enrollment.
- Collaborating with members, caregivers, providers, and interdisciplinary teams to develop and implement individualized care plans.
- Authorizing services within program guidelines and connecting members to community resources.
- Documenting all activities accurately and timely in the electronic health record.
- Applying advanced clinical judgment and critical thinking to resolve complex care issues.
- Mentoring new hires upon reaching proficiency in the role.
- Licensed Clinical Social Worker or Licensed Social Worker
- 2+ years Behavioral Health experience/ expertise required .
- Strong Assessment, communication and documentation skills
- Successful completion of NJ Choice Certification (80% or higher required for continued employment).
- Ability to work independently in a telework environment during standard business hours.
- 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
- Case management and/or discharge planning experience preferred.
- Managed Care experience preferred
- Crisis intervention skills preferred
Master's Degree Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:$72,627.00 - $155,538.00This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.