Clinical Case Manager Behavioral Health FIELD
| Company | CVS Health |
|---|---|
| Location | Clarksburg, WV, USA, Steubenville, OH, USA, Fairmont, WV, USA, Morgantown, WV, USA, Toronto, OH, USA, White Hall, WV, USA, West Virginia, USA, Parkersburg, WV, USA, Wheeling, WV, USA, Clendenin, WV, USA |
| Salary | $54095 – $116760 |
| Type | Full-Time |
| Degrees | Master’s |
| Experience Level | Mid Level, Senior |
Requirements
- Unencumbered West Virginia (WV) Behavioral Health clinical license (LPC, LMFT, LICSW, LGSW)
- 3+ years of direct clinical practice experience post Master’s degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
- Must be West Virginia resident
- Qualified candidates must reside in one of the following counties: Barbour, Brooke, Doddridge, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Ritchie, Taylor, Tyler, Upshur, Wetzel
- Must possess reliable transportation and be willing and able to travel in the assigned region 50% or more, of the time. Mileage is reimbursed per our company expense reimbursement policy.
- 2+ years of experience with personal computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams)
Responsibilities
- Conducts comprehensive assessments of referred member’s needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member’s 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.
- 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.
- Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
- 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.
- Speaks to medical and behavioral health professionals to influence appropriate member care.
- Utilizes 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.
- Develops and monitors established plans of care to meet the member’s goals in collaboration with the member and their care team.
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Preferred Qualifications
- Waiver experience
- Foster care experience
- Crisis intervention skills
- Managed care/utilization review experience
- Case management experience in an integrated model
- Case management and discharge planning experience
- Certified Case Manager (CCM) certification
- Familiarity with QuickBase