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.Business Overview:The Aetna Better Health of West Virginia plan has a successful, 26+ year history of partnering with the State to provide West Virginia's Medicaid population with top notch health care coordination and service. The plan also has been chosen to provide care coordination to complex foster care children of the state. Through a strong, localized team, an innovative care management model, and creative provider and community advocacy partnerships, Aetna Better Health of West Virginia has successfully assisted the State in achieving high quality standards and outcomes for the Medicaid population across the state. The health plan truly embodies the commitment of West Virginian's helping West Virginian's. At Aetna Better Health of West Virginia, you can be the very best you can be working with strong teams committed to helping our members and with opportunities for career growth. We will support you all the way!Position SummaryThis is a full-time field teleworker position that requires West Virginia residency. Travel is required 50% of the time or more, in the Northern region of WV. Field based travel locations may include member homes, residential treatment facilities, group homes, shelters, and detention facilities. Qualified candidates must reside in one of the following counties: Barbour, Brooke, Doddridge, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Ritchie, Taylor, Tyler, Upshur, WetzelThe Clinical Care Manager BH utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal , cost-effective outcomes. This position is heavy community-based with some onsite presence at Department of Health and Human Resources (DHHR) offices.Schedule is Monday - Friday, 8am-5pm, standard business hours. No nights, weekends, and no holidays. A flexible work schedule may be available after 6 months of service and with demonstrated performance and attendance.Fundamental Components:• Assessment of Members:o Through the use of clinical tools and information/data review, conducts comprehensive assessments of referredmember's needs/eligibility and determines approach tocase resolution and/or meeting needs by evaluatingmember's benefit plan and available internal and externalprograms/services.o Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complexclinical indicators which impact care planning and resolution of member issues.o Using advanced clinical skills, performs crisis interventionwith members experiencing a behavioral health or medicalcrisis and refers them to the appropriate clinical providersfor thorough assessment and treatment, as clinicallyindicated.o Provides crisis follow up to members to help ensure theyare receiving the appropriate treatment/services .• Enhancement of Medical Appropriateness and Quality of Care:o Application and/or interpretation of applicable criteria andclinical guidelines, standardized case management plans,policies, procedures, and regulatory standards whileassessing benefits and/or member's needs to ensureappropriate administration of benefits.o Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes.o Identifies and escalates quality of care issues through established channels.o Ability to speak to medical and behavioral health professionals to influence appropriate member care.o Utilizes motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health.o Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.o Helps member actively and knowledgably participate with their provider in healthcare decision-making.o Analyzes all utilization , self-report, and clinical data available to consolidate information and begin to identify comprehensive member needs.• Monitoring, Evaluation and Documentation of Care:o In collaboration with the member and their care team develops and monitors established plans of care to meet the member's goals.o Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.• Effective communication skills, both verbal and written.Required Qualifications• Unencumbered West Virginia (WV) Behavioral Health clinical license (LPC, LMFT, LICSW, LGSW)• 3+ years of direct clinical practice experience post Master's degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility• Must be West Virginia resident
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- Qualified candidates must reside in one of the following counties: Barbour, Brooke, Doddridge, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Ritchie, Taylor, Tyler, Upshur, Wetzel
- Case management experience in an integrated model
• Minimum of a Master's degree in Behavioral /Mental Health or related field. Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:$54,095.00 - $116,760.00This 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.