Clinical Case Manager, Transitions of Care, Behavioral Health

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

This is a full-time field-based teleworker opportunity in Oklahoma.Qualified candidates preferably will reside within the region which includes the following counties:

Harmon, Greer, Jackson, Kiowa, Comanche, Caddo, Cotton, Grady, Stephens, Jefferson, Cleveland, McClain, Garvin, Murray, Carter, Lowe, Marshall, Johnston, Pottawatomie, and Lincoln.Typical working schedule: Monday - Friday 8am-5pm.Responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). 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 wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes.

• Responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all care management activities with members to evaluate the medical and behavioral health needs to facilitate the member's overall wellness.
• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration.
• Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.

• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.
• Completes assessments taking into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality and include the member's restrictions/ limitations.
• Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
• Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
• 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.
• Using holistic approach consults with manager, 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 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.
• Ability to speak to medical and behavioral health professionals to influence appropriate member care.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgably participate with their provider in healthcare decision-making.
• Analyzes utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
• 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 and company policies and procedures.
• Facilitates clinical hand offs during transitions of care.

• Must reside in Oklahoma
• Oklahoma-licensed mental health professional: Licensed Professional Counselor (LPC), Licensed Marriage & Family Therapist (LMFT) Licensed Behavioral Practitioner (LBP), or Licensed Clinical Social Worker (LCSW) with current unencumbered license.
• 3+ years clinical practice experience (e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility)
• 2+ years of experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
• Must possess reliable transportation and be willing and able to travel in-state up to 30% of the time. Mileage is reimbursed per our company expense reimbursement policy.

• Experience providing care to diverse populations
• 1+ year(s) of crisis intervention experience
• Managed care/utilization review experience
• Case management and discharge planning experience

• Minimum of a master's degree in behavioral health field (e.g., counseling, marriage & family therapy, or social work) required

• 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.