BH Clinical Case Manager (Southwest Region) CARDINAL

Job DescriptionThis is a full time remote teleworker opportunity in Virginia. The BH Clinical Case Manager 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. Travel is required, 25-40% of the time, in the Southwest region.Fundamental Components: Assessment of Members: o Conducts face-to-face member visits.o Through the use of clinical tools and information/data review, 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 strategiesdesigned to reduce risk factors and address complexclinical indicators which impact care planning and resolution of member issues.o Using advanced clinical skills, performs crisis interventionwith members experiencing a behavioral health or medicalcrisis and refers them to the appropriate clinical providersfor thorough assessment and treatment, as clinicallyindicated.o Provides crisis follow up to members to help ensure theyare receiving the appropriate treatment/services. Enhancement of Medical Appropriateness and Quality of Care: o Application and/or interpretation of applicable criteria andclinical guidelines, standardized case management plans,policies, procedures, and regulatory standards whileassessing benefits and/or member's needs to ensureappropriate administration of benefits. o 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.o Identifies and escalates quality of care issues through established channels. o Ability to speak to medical and behavioral health professionals to influence appropriate member care.o Utilizes motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health.o Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.o Helps member actively and knowledgably participate with their provider in healthcare decision-making.o 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: o In collaboration with the member and their care team develops and monitors established plans of care to meet the member's goals. o Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines 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 (e.g., LCSW, LPC). Resides in VA; and in Southwest region. Ability to travel with personal vehicle, 25-40% of the time. Must possess reliable transportation, active driver's license, and proof of vehicle insurance. Demonstrated proficiency with personal computer, keyboard, multi-system navigation; and with MS Office Suite applications (Outlook, Word, Excel, SharePoint).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 Crisis intervention skills preferred. Medicaid experience preferred. Managed care experience preferred. Case management and discharge planning experience preferred.EducationMinimum of a Master's degree in Behavioral/Mental Health.Business OverviewAt 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.

Created: 2025-11-15