CVS Health Clinical Case Manager BH in Blue Bell, Pennsylvania
This position will be a full-time telework anywhere in the United States. Schedule is Monday-Friday, standard business hours.No nights, no weekends and no holidays.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. - Monitor clinical care services provided to members related to mental health and substance abuse treatment to optimize clinical outcomes. - Provide telephone triage and crisis intervention. - Provide information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Aetna Behavioral Health policies and procedures, and criteria. - Interact with Physician Advisors to discuss clinical questions and concerns regarding specific cases. - Participate in QI activities including data collection, tracking, and analysis. Telephonic clinical case management with Medicare population. - Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs. - Completes a Comprehensive Assessment and Plan of care. - Will document in clinical systems to support legacy Aetna and Coventry membership.- Provides BH consultation and collaboration with Aetna partners. - Active participation in clinical treatment rounds. - Active participation in team activities focused on program development. Innovative thinking expected.
- 3+ years of direct clinical practice experience post degree e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.- RN (current and unrestricted license) with behavioral health or DSNP experience required OR a qualifying BH degree (i.e. LPC, LPCC, LISW, LSW, LCSW)- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Work requires sitting for extended periods, talking on the telephone and typing into the computer.
- 2+ years of managed care experience highly preferred- 2+ years of case management experience- 2+ years of behavioral health experience- Discharge planning experience- Utilization review, prior authorization, concurrent review, appeals experience- Advanced crisis intervention skills- CCM preferred
- RN licensure (current and unrestricted license) OR a minimum of a Master's degree with a qualifying BH licensure (i.e. LPC, LPCC, LISW, LSW, LCSW)
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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