Care Management Associate (Autism Spectrum Disorder)

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
The Care Management Associate (Autism Spectrum Disorder) is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating), focusing on members primarily diagnosed with ASD ( Autism Spectrum Disorder ). This person utilizes clinical judgment and critical thinking skills to facilitate appropriate member physical and behavioral healthcare through assessment and care planning. They will facilitate provider coordination/collaboration, as well as coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.Position Responsibilities:

• Responsible for planning, implementing, and coordinating care management activities with members and family to ensure that their medical and behavioral health needs are met, as well as to enhance the member's overall wellness.
• Develops a proactive course of action to address issues presented and facilitate short and long-term outcomes, as well as identify opportunities to enhance a member's overall health through integration.
• Through the use of clinical tools and information/data review, conducts comprehensive assessments of member's needs. Recommends an approach to case resolution by meeting needs in alignment with their benefit plan and available internal and external programs and services.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors. Addresses complex clinical and social indicators that impact care planning and resolution of member issues.
• Completes assessments that take into account information from various sources to address all conditions, including co-morbid and multiple diagnoses that impact functionality and the member's restrictions/limitations.
• Analyzes utilization, self-report, and clinical data available to consolidate information and begin to identify comprehensive member needs.
• Using clinical skills, facilitates care coordination with consideration for the member, provider, health plan, and regulator.
• Applies and interprets 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.
• Serves as a single point of contact for members and family-assisting members to remediate immediate and acute gaps in care and access.
• Using holistic approach, consults with managers, medical directors, and/or other physical/behavioral health support staff and providers to overcome barriers to meeting goals and objectives.
• Presents cases at case conferences/rounds to obtain multidisciplinary view in order to achieve optimal outcomes.
• Works collaboratively with the members' interdisciplinary care team.
• Identifies and escalates quality of care issues through established channels.
• Communicates with medical and behavioral health professionals to influence appropriate member care.
• Utilizes influencing/motivational interviewing skills to ensure maximum memberengagement and discern their health status and needs, based on key questions andconversation.
• Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Provides guidance to the member and family in identifying and utilizing health plan and community resources to enhance the member's overall health and wellness.
• Helps member actively and knowledgably participates with their provider in healthcare decision-making.
• 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, as well as company policies and procedures.
• Facilitates clinical hand-offs during transitions of care.

• 2+ years of experience with direct clinical practice and/or managed care.
• 2+ years of experience using personal computer, keyboard navigation, and navigating multiple systems and applications, as well as using Microsoft Office Suite applications (Teams, Outlook, Word, Excel, etc.).

• 1+ year of experience in ABA (Applied Behavioral Analysis) therapy practice.
• Previous experience in case management and discharge planning.
• Previous experience working with the Autism Spectrum Disorder population.
• Previous experience with community and/or individual outreach.
• Resides in Arizona.
• Bachelor's degree in Behavioral/Mental Health or related field.

• Bachelor's degree or equivalent experience (High school diploma or GED + 4 years of relevant experience).

• 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.