CVS Health Clinical Case Manager Behavioral Health in Tucson, Arizona
This role is work from home with travel required in Pima County, AZ to visit members once COVID restrictions are lifted.
-Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
-Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for members by providing care coordination, support and education for members through the use of care management tools and resources.
Evaluation of Members; Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
-Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referrals.
Coordinates and implements assigned care plan activities and monitors care plan progress.
Enhancement of Medical Appropriateness and Quality of Care;
-Uses a holistic approach to overcome barriers to meet goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
Identifies and escalates quality of care issues through established channels.
-Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
-Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
-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. Monitoring, Evaluation, and Documentation of Care;
-Utilizes case management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
3+ years of direct clinical practice experience post masters degree required for LPC, LISAC,LCSW, LAC, LMSW
-3+ years direct clinical practice required for post licensure for RN
-Unencumbered Behavioral Health clinical license in the state where they work is required (i.e. LPC, LISAC, LCSW, LAC,LMSW, or RN)
-2+ years Case Management
-2+ years experience working with people who have been designated as having a serious mental illness (SMI) and working with people who are elderly or have a physical disability.
-Excellent with written and verbal communication
-25-50% travel is required post COVID restrictions. Travel includes member visits and working in the office.
- Work hours are M-F, 8am - 5pm.
-Computer proficient with outlook, windows, and word.
-Experience collaborating with medical professionals
-Crisis intervention skills preferred
-Managed care/utilization review experience preferred
- Discharge planning experience
Bachelor's degree or equivalent experience for RN licensure
Master's degree in behavioral/mental health with licensure LPC, LISAC,LCSW, LAC, LMSW
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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