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Job DescriptionThis is a full time remote teleworker position in Virginia. Travel is required 25-40% of the time in the Northern / Winchester Region of VA. Qualified candidates must reside in one of the following counties: Alexandria. Falls Church, Page, Arlington, Fauquier, Prince William, Clarke, Frederick, Rappahannock, Culpeper, Loudoun, Shenandoah, Fairfax City, Manassas City, Warren, Fairfax Co., Manassas Park, Winchester.Hours for this position are Monday-Friday 8:00am – 5:00pm EST.The BH Clinical Case Manager 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: Assessment of Members:o Conducts face-to-face member visits.o Through the use of clinical tools and information/datareview, conducts comprehensive assessments of referredmember's needs/eligibility and determines approach tocase resolution and/or meeting needs by evaluatingmember's benefit plan and available internal and externalprograms/services.o Applies clinical judgment to the incorporation of strategiesdesigned to reduce risk factors and address complexclinical indicators which impact care planning and resolutionof member issues.o Using advanced clinical skills, performs crisis interventionwith members experiencing a behavioral health or medicalcrisis and refers them to the appropriate clinical providersfor thorough assessment and treatment, as clinicallyindicated.o Provides crisis follow up to members to help ensure theyare receiving the appropriate treatment/services. Enhancement of Medical Appropriateness and Quality ofCare:o Application and/or interpretation of applicable criteria andclinical guidelines, standardized case management plans,policies, procedures, and regulatory standards whileassessing benefits and/or member's needs to ensureappropriate administration of benefits.o Using holistic approach consults with supervisors,Medical Directors and/or other programs to overcomebarriers to meeting goals and objectives; presents cases atcase conferences to obtain multidisciplinary view in order toachieve optimal outcomes.o Identifies and escalates quality of care issues throughestablished channels.o Ability to speak to medical and behavioral healthprofessionals to influence appropriate member care.o Utilizes motivational interviewing skills to ensuremaximum member engagement and promoteslifestyle/behavior changes to achieve optimum level ofhealth.o Provides coaching, information and support to empowerthe member to make ongoing independent medical and/orhealthy lifestyle choices.o Helps member actively and knowledgably participate withtheir provider in healthcare decision-making.o Analyzes all utilization, self-report and clinical dataavailable to consolidate information and begin to identifycomprehensive member needs. Monitoring, Evaluation and Documentation of Care:o In collaboration with the member and their care teamdevelops and monitors established plans of care to meetthe member's goals.o Utilizes case management and quality managementprocesses in compliance with regulatory and accreditationguidelines and company policies and procedures.Pay RangeThe typical pay range for this role is:Minimum: 58,760Maximum: 125,840Please 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 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). Unencumbered Behavioral Health clinical license in VA (LCSW, LPC, or LBA ) Resides in the Northern/Winchester region of VA. Must possess reliable transportation and be willing and able to travel 25-40% of the time. Mileage is reimbursed per our company expense reimbursement policy. 2+ years experience with personal computer, keyboard, mouse, multi-system navigation; and with MS Office Suite applications (Outlook, Word, Excel, SharePoint).Preferred Qualifications Experience with Substance Use Disorders Crisis intervention skills Medicaid experience Managed care experience Case management and discharge planning experienceEducation Minimum of a Master's degree in Behavioral/Mental HealthBusiness OverviewBring your heart to CVS Health Every 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Vacancy expired!