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Clinical Case Manager BH-Field-Virginia

Company: CVS Health
Location: Richmond
Posted on: November 20, 2023

Job Description:

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors--- support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
Hours for this position are Monday-Friday 8:00am to 5:00pm EST.The Clinical Case 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.Fundamental Components:

  • Assessment of Members:o Conducts face-to-face member visits.o Through the use of clinical tools and information/datareview, 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 complex clinical indicators which impact care planning and resolution of member issues.o 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.o Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.

  • Enhancement of Medical Appropriateness and Quality of Care:o Application and/or interpretation of 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.o Using holistic approach consults with supervisors,Medical Directors and/or other programs to overcomebarriers 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 throughestablished channels.o Ability to speak to medical and behavioral healthprofessionals to influence appropriate member care.o Utilizes motivational interviewing skills to ensuremaximum member engagement and promoteslifestyle/behavior changes to achieve optimum level ofhealth.o Provides coaching, information and support to empower the member to make ongoing independent medical and/orhealthy lifestyle choices.o Helps member actively and knowledgably participate withtheir provider in healthcare decision-making.o Analyzes all utilization, self-report and clinical dataavailable to consolidate information and begin to identifycomprehensive member needs.

  • Monitoring, Evaluation and Documentation of Care:o In collaboration with the member and their care teamdevelops and monitors established plans of care to meetthe member's goals.o Utilizes case management and quality managementprocesses in compliance with regulatory and accreditationguidelines and company policies and procedures.

    Required Qualifications:

    • 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).

    • Unencumbered Behavioral Health clinical license in VA (LCSW, LPC or LBA)

    • Must have reliable transportation and must be willing and able to travel within the assigned region 25-40% of the time. Mileage is reimbursed per our company expense reimbursement policy.

      Preferred Qualifications:

      • 2+ years demonstrated experience with personal computer, keyboard, mouse, multi-system navigation, and with MS Office Suite applications (Outlook, Word, Excel, SharePoint).

      • Crisis intervention skills

      • Medicaid experience

      • Managed care experience

      • Case management and discharge planning

      • Experience with Substance Use Disorders

        Master's in Social Work, Behavior, Professional Counseling, Marriage and Family.
        Pay Range
        The typical pay range for this role is:
        $58,760.00 - $125,840.00
        This 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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit
        CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
        You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
        CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.

Keywords: CVS Health, Richmond , Clinical Case Manager BH-Field-Virginia, Executive , Richmond, Virginia

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