Full-Time

Bilingual – Clinical Case Manager

Behavioral Health

Posted on 1/17/2025

CVS Health

CVS Health

10,001+ employees

Comprehensive pharmacy and healthcare services

Healthcare
Consumer Goods

Compensation Overview

$54.1k - $116.8kAnnually

+ Bonus + Commission + Short-term Incentive Program

Mid, Senior

Company Historically Provides H1B Sponsorship

Miami, FL, USA

Must reside in the Miami area; up to 40% travel within Miami-Dade and Monroe counties.

Category
Nursing & Allied Health Professionals
Medical, Clinical & Veterinary
Required Skills
Word/Pages/Docs
Excel/Numbers/Sheets

You match the following CVS Health's candidate preferences

Employers are more likely to interview you if you match these preferences:

Degree
Experience
Requirements
  • Bilingual in Spanish or Creole
  • Must reside in the Miami area
  • Licensed mental health professional with current unencumbered license in the state of FL: Licensed Mental Health Counselor (LMHC), Licensed Marriage & Family Therapist (LMFT), PsyD, or Licensed Clinical Social Worker (LCSW)
  • Willing and able to travel up to 40% of their time within the Miami-Dade and Monroe counties to visit members face to face
  • 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
  • 2+ years of experience managing members with serious mental illness
  • 2+ years of experience using crisis intervention skills
  • 2+ years of experience providing care to a diverse population
  • 2+ years of experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
Responsibilities
  • Responsible for telephonic and/or face to face assessment, planning, implementing and coordinating care management activities with members to ensure that their medical and behavioral health needs are met and to enhance the member’s overall wellness.
  • Develops a proactive course of action to address issues presented and facilitate short and long-term outcomes as well as identify opportunities to enhance a member’s overall health through integration.
  • Through the use of clinical tools and information/data review, conducts comprehensive assessments of member’s needs and recommends an approach to case resolution by meeting needs in alignment with their benefit plan and available internal and external programs and services.
  • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical and social indicators which impact care planning and resolution of member issues.
  • Completes assessments that take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality and the member’s restrictions/limitations.
  • Analyzes utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
  • Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health 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 and services.
  • Applies and interprets 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.
  • Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access.
  • Using holistic approach consults with managers, medical directors and/or other physical/behavioral health support staff and providers to overcome barriers to meeting goals and objectives/
  • Presents cases at case conferences/rounds to obtain multidisciplinary view in order to achieve optimal outcomes.
  • Works collaboratively with the members’ interdisciplinary care team.
  • 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 discern their health status and health needs based on key questions and conversation.
  • 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.
  • In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals.
  • Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
  • Facilitates clinical hand offs during transitions of care.
Desired Qualifications
  • Managed care/utilization review experience
  • Case management and discharge planning experience

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines retail pharmacy services with a pharmacy benefits manager and senior care services, making it a comprehensive provider in the healthcare sector. The company's goal is to enhance access to quality care and support people in achieving better health.

Company Stage

Debt Financing

Total Funding

N/A

Headquarters

Woonsocket, Rhode Island

Founded

1963

Simplify Jobs

Simplify's Take

What believers are saying

  • Telehealth expansion offers CVS Health growth opportunities in virtual care services.
  • AI in pharmacy operations can improve CVS Health's efficiency and customer satisfaction.
  • Health and wellness apps provide CVS Health avenues to engage customers and improve outcomes.

What critics are saying

  • DOJ legal challenges over opioid prescriptions could harm CVS Health's reputation and finances.
  • Supply chain vulnerabilities, highlighted by the Horizon Milk recall, may impact consumer trust.
  • Competition from retailers like Walmart and Amazon could affect CVS's market share in CRC tests.

What makes CVS Health unique

  • CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.
  • The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.
  • CVS Health offers a wide range of health products, enhancing accessibility and affordability.

Help us improve and share your feedback! Did you find this helpful?

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

INACTIVE