Clinical Case Manager Behavioral Health - Cook County ...

Job DescriptionThis position is dedicated to the Transition Team of ABH-IL. Candidate can be located anywhere in Cook county or adjoining counties.This position would require up to 75% travel to IMD and NF within Cook County and possibly IMD's in Peoria and Decatur.This CMBH will be involved in discharge planning of Colbert and Williams Consent Decree members. -Assess member if appropriate for discharge-Identify support needed by member to be successful in the community -provide follow up post dischargeUtilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare throughassessment and care planning, direct provider coordination/collaboration,and coordination of psychosocial wraparound services to promote effectiveutilization of available resources and optimal, cost-effective outcomes.Assessment of Members: Through the use of clinical tools andinformation/data review, conducts comprehensive assessments of referredmember's needs/eligibility and determines approach to case resolutionand/or meeting needs by evaluating member's benefit plan and availableinternal and external programs/services. - Applies clinical judgment to theincorporation of strategies designed to reduce risk factors and addresscomplex clinical indicators which impact care planning and resolution ofmember issues. - Using advanced clinical skills, performs crisis interventionwith members experiencing a behavioral health or medical crisis and refersthem to the appropriate clinical providers for thorough assessment andtreatment, as clinically indicated. Provides crisis follow up to members tohelp ensure they are receiving the appropriate treatment/services.Enhancement of Medical Appropriateness and Quality of Care: - Applicationand/or interpretation of applicable criteria and clinical guidelines,standardized case management plans, policies, procedures, and regulatorystandards while assessing benefits and/or member's needs to ensureappropriate administration of benefits - Using holistic approach consultswith supervisors, Medical Directors and/or other programs to overcomebarriers to meeting goals and objectives; presents cases at caseconferences to obtain multidisciplinary view in order to achieve optimaloutcomes - Identifies and escalates quality of care issues throughestablished channels -Ability to speak to medical and behavioral healthprofessionals to influence appropriate member care. - Utilizesinfluencing/motivational interviewing skills to ensure maximum memberengagement and promotes lifestyle/behavior changes to achieve optimumlevel of health -Provides coaching, information and support to empower themember to make ongoing independent medical and/or healthy lifestylechoices. -Helps member actively and knowledgably participate with theirprovider in healthcare decision-making -Analyzes all utilization, self-reportand clinical data available to consolidate information and begin to identifycomprehensive member needs. Monitoring, Evaluation and Documentationof Care: -In collaboration with the member and their care team developsand monitors established plans of care to meet the member's goals -Utilizescase management and quality management processes in compliance withregulatory and accreditation guidelines and company policies andprocedures.Pay RangeThe typical pay range for this role is:Minimum: 26.59Maximum: 57.21Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications-Active and unrestricted Clinical BH license ( LCSW or LCPC) in the state of IL.-3 years of Clinical experience required.-Minimum 1 year of experience in Colbert and Williams Consent decree-Willing and able to travel up to 75% of their time to meet members face to face in Cook county IL and possibly to Peoria county and Decatur and surrounding areas.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 Qualifications2 yrs experience in MCO3 yrs experience in LTCCase Management and discharge planningEducationMaster's degree in Behavioral/Mental Health/Social Work 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: 2025-11-15