Clinical Case Manager Behavioral Health

Job DescriptionThis is telework position with 50-75% travel required within Perry/ Jefferson/Washington counties in IL and surrounding areas.Qualified candidates must be located in Perry, Jefferson or Washington Counties of ILAs a Clinical Case Manager you will facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members throughthe use of care management tools and resources.Evaluation of Members:-Through the use of care management tools and information/data review, conductscomprehensive evaluation of referred member's needs/eligibility and recommends anapproach to case resolution and/or meeting needs by evaluating member's benefitplan and available internal and external programs/services.- Identifies high risk factors and service needs that may impact member outcomes andcare planning components with appropriate referral to clinical case management orcrisis intervention as appropriate.- Coordinates and implements assigned care plan activities and monitors care planprogress.Enhancement of Medical Appropriateness and Quality of Care:- Using holistic approach consults with case managers, supervisors, Medical Directorsand/or other health programs to overcome barriers to meeting goals and objectives;presents cases at case conferences to obtain multidisciplinary review in order toachieve optimal outcomes.- Identifies and escalates quality of care issues through established channels.- Utilizes negotiation skills to secure appropriate options and services necessary tomeet the member's benefits and/or healthcare needs.- Utilizes influencing/ motivational interviewing skills toensure maximum member engagement and promotelifestyle/behavior changes to achieve optimum level ofhealth.- Provides coaching, information and support toempower the member to make ongoing independentmedical and/or healthy lifestyle choices.- Helps member actively and knowledgeably participate with their provider inhealthcare decision-making.Monitoring, Evaluation and Documentation of Care:- Utilizes case management and quality management processes in compliance withregulatory and accreditation guidelines and company policies and procedures.Required Qualifications- Minimum 2 years of experience in behavioral health, social services or human services field.- Active and unrestricted Clinical Behavioral Health License (LCPC, LCSW,LMFT) required in the state of IL. - Wiling and able to travel 50-75% of their time using their own vehicle to meet members face to face in Perry, Jefferson and Washington counties in IL and surrounding areas.-Valid Driver's License Required.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- Case management and discharge planning experience- Experience working with individuals with HIV diagnosis.- Managed Care experience- Microsoft Office experienceEducationMaster's degree in the field of Social Services, Behavioral Health or Human Services field required.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: 2025-10-04