Clinical Case Manager Behavioral Health - Field - reside in Western Chicago Suburbs

Position: Clinical Case Manager Behavioral Health - Field - Must reside in Western Chicago Suburbs

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.

And we do it all with heart, each and every day.

Position Summary

This Clinical Case Manager Behavioral Health position is with Aetna’s Long-Term Services and Supports (LTSS) team and is a field-based position out of the western Chicago suburban area of Illinois (e.g., Addison, Elmhurst, Lombard, Oak Brook, etc.). The requirements is for candidates to hold a Behavioral Health License (specifically LCSW, LCPC, or LMFT), and travel 50-75% of the time to meet with members face to face.

This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meet contractual requirements. Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources.

Evaluation of Members

• Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members’ needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members’ benefit plan and available internal aid and external programs/services.
• Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
• Coordinates and implements assigned care plan activities and monitors care plan progress.

Enhancement of Medical Appropriateness and Quality of Care

• Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote 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 knowledgeably participate with their provider in healthcare decision-making.

Monitoring, Evaluation and Documentation of Care

• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

• Active Illinois BH clinical license - specifically LCSW, LCPC, or LMFT
• Must reside in Addison, Elmhurst, Lombard, Oak Brook, or Surrounding Area
• Valid Illinois Driver’s License
• Willing and able to travel up to 50%-75% of their time to meet with members face to face
• Reliable Transportation required, eligible for mileage reimbursement as per company policy
• Minimum two (2) years of case management experience
• Microsoft Office and electronic health record experience

Preferred Qualifications

• Case management and discharge planning experience
• Managed Care experience
• Microsoft Office experience
• Experience working with HIV and AIDS population

Education

• Master’s degree in social work, counseling, or related field

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:
$66,575.00 - $
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,…