Behavioral Health Clinical Case Manager - LCPC/LCSW - ...

Weu2019re building a world of health around every individual u2014 shaping a more connected, convenient and compassionate health experience. At CVS Healthu00ae, youu2019ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger u2013 helping to simplify health care one person, one family and one community at a time. Position Summary Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. Position Summary/Mission 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. Fundamental Components & Physical Requirements (Include but are not limited to) Assessment of Members + Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred memberu2019s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating memberu2019s 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 memberu2019s 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 memberu2019s goals + Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Required Qualifications + Candidate must reside in Illinois + Candidate must possess reliable transportation and be willing and able to travel up to 25% of the time in and around candidates home locations (Mileage is reimbursed per our company expense reimbursement policy) + Candidate must have active and unrestricted Licensed Clinical Social Worker (LCSW)/ Licensed Clinical Professional Counselor (LCPC) in Illinois + 3-5 years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility + Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually + Excellent analytical and problem-solving skills + Effective communications, organizational, and interpersonal skills. + Ability to work independently + Effective computer skills including navigating multiple systems and keyboarding + Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications Preferred Qualifications + Case management and discharge planning experience + Managed care/utilization review experience + Crisis intervention skills Education + Master's Degree in Behavioral/Mental Health or related field (REQUIRED) License + Active and unrestricted Licensed Clinical Social Worker (LCSW)/ Licensed Clinical Professional Counselor (LCPC) in Illinois Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $66,575.00 - $142,576.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This fullu2011time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellu2011being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments (. We anticipate the application window for this opening will close on: 06/30/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran u2014 committed to diversity in the workplace.

Created: 2026-05-08