Clinical Case Manager Behavioral Health

Job DescriptionThe position is work from home with a travel requirement of up to 25% within the state of West Virginia.Schedule is Monday-Friday standard business hours. No nights, no weekends and no holidays. Must reside in WV and manage territory within region they reside in West Virginia.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.Assessment of Members:-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.- 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.Enhancement of Medical Appropriateness and Quality of Care:- 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- 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- 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 promotes 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-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:-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.Required Qualifications- Minimum 3 years of direct clinical practice experience, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.-Must be West Virginia Resident.-Must have valid West Virginia Drivers license and clean driving record.-Must be willing and able to travel up to 25% (once COVID restrictions are lifted) using your own vehicle to meet members face to face within the state of WV.-Active and unrestricted Behavioral Health Licensure valid in the state of West Virginia. ( Ex - LPC, LCSW, LMFT,LCPC, etc.)COVID RequirementsCOVID-19 Vaccination RequirementCVS 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.Preferred Qualifications-Behavioral health or waiver experience preferred-Foster care experience preferred-Crisis intervention skills preferred-Managed care/utilization review experience preferred-Case management and discharge planning experience preferredEducationMinimum of a Master's degree in Behavioral/Mental Health/Social work or Human service field.Business OverviewBring your heart to CVS HealthEvery 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-06-14