Field Clinical Case Manager - Behavioral Health
Company: CVS Pharmacy
Location: Bloomington
Posted on: August 6, 2022
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Job Description:
Job DescriptionFamily Summary/MissionDevelop, implement,
support, and promote Health Services strategies, tactics, policies,
and programs that drive thedelivery 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
coverageand policies.Position Summary/MissionUtilizes advanced
clinical judgment and critical thinking skills to facilitate
appropriate member physical health andbehavioral healthcare through
assessment and care planning, direct provider
coordination/collaboration, and coordinationof psychosocial
wraparound services to promote effective utilization of available
resources and optimal, cost-effectiveoutcomes.Fundamental
Components & Physical Requirements include but are not limited to (
denotes essential functions) Assessment of Members: Through the use
of clinical tools and information/data review, conducts
comprehensive assessments of referredmember's needs/eligibility and
determines approach to case resolution and/or meeting needs by
evaluating member'sbenefit plan and available internal and external
programs/services.- Applies clinical judgment to the incorporation
ofstrategies designed to reduce risk factors and address complex
clinical indicators which impact care planning andresolution of
member issues.- Using advanced clinical skills, performs crisis
intervention with members experiencing a behavioral health or
medicalcrisis and refers them to the appropriate clinical providers
for thorough assessment and treatment, as clinicallyindicated.
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 criteriaand clinical guidelines,
standardized case management plans, policies, procedures, and
regulatory standards whileassessing benefits and/or member's needs
to ensure appropriate administration of benefits- Using holistic
approach consults with supervisors, Medical Directors and/or other
programs to overcome barriers tomeeting goals and objectives;
presents cases at case conferences to obtain multidisciplinary view
in order to achieveoptimal 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/orhealthy lifestyle
choices.-Helps member actively and knowledgably participate with
their provider in healthcare decision-making 1-Analyzes all
utilization, self-report and clinical data available to consolidate
information and begin to identifycomprehensive member needs.
Monitoring, Evaluation and Documentation of Care:-In collaboration
with the member and their care team developsand monitors
established plans of care to meet the member's goals-Utilizes case
management and quality management processes in compliance with
regulatory and accreditationguidelines and company policies and
procedures.Required Qualifications- 3+ 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- Must be willing to travel 50-75% to McLean and
Livingston Counties- Unencumbered Behavioral Health clinical
license LCSW or LCPC is requiredCOVID 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- Managed care/utilization review experience
preferred- Crisis intervention skills preferredEducationMaster's
degree requiredBusiness 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.
Keywords: CVS Pharmacy, Bloomington , Field Clinical Case Manager - Behavioral Health, Executive , Bloomington, Illinois
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