Bring 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.

This is a telework position and the care manager must work normal business hours of Monday - Friday 8:00am - 5:00pm EST; no weekends or holidays.

The Clinical Case Manager is responsible for conducting face to face visits in acute mental health facilities and PRTFs, members homes, and in the community.

Must have reliable transportation and be willing and able to travel up to 25 - 50% of the time within NJ as needed. Applicants must reside within New Jersey.

Position Summary

Applies advanced clinical judgement to facilitate appropriate member physical health and behavioral healthcare. Implements strategy to assess and plan care, direct provider collaboration, and coordinate psychosocial wraparound services. Instructs the application of available resources to produce optimal, cost-effective outcomes.

The most rewarding aspect of the Clinical Care Management role is evidenced by the positive outcomes of collaborative efforts between the care manager, member, and servicing providers.

• Executes comprehensive assessments of member needs and eligibility by evaluating member benefit plans and available services.
• Develops strategies to reduce risk factors and address complex clinical indicators that impact care planning and issue resolution.
• Acts as a top-level specialist to perform crisis intervention with members experiencing a behavioral health or medical crisis, refers appropriate providers, and follows up to ensure members are receiving the appropriate services.
• Adapts clinical guidelines, standardized case management procedures, and regulatory standards to needs assessments to ensure appropriate administration of benefits.
• Counsels with medial and behavioral health professionals to influence appropriate member care.
• Coaches members to make ongoing independent medical and healthy lifestyle choices, and to actively participate with providers in healthcare decision-making.
• Coaches and trains junior colleagues in techniques, processes, and responsibilities.
• Responsible to coordinate and collaborate care with member/authorized representative, PCP, and any other care team participant
• Attend interdisciplinary meetings and advocate on members behalf
• Work with the member and care team to coordinate and assist with community resources
• Documenting accurately and timely in the electronic health record
• Use critical thinking and be able to problem solve any issues related to assigned membership

Required Qualifications
A Brief Overview
Applies advanced clinical judgement to facilitate appropriate member physical health and behavioral healthcare. Implements strategy to assess and plan care, direct provider collaboration, and coordinate psychosocial wraparound services. Instructs the application of available resources to produce optimal, cost-effective outcomes.

What you will do

• Executes comprehensive assessments of member needs and eligibility by evaluating member benefit plans and available services.
• Develops strategies to reduce risk factors and address complex clinical indicators that impact care planning and issue resolution.
• Acts as a top-level specialist to perform crisis intervention with members experiencing a behavioral health or medical crisis, refers appropriate providers, and follows up to ensure members are receiving the appropriate services.
• Adapts clinical guidelines, standardized case management procedures, and regulatory standards to needs assessments to ensure appropriate administration of benefits.
• Counsels with medial and behavioral health professionals to influence appropriate member care.
• Coaches members to make ongoing independent medical and healthy lifestyle choices, and to actively participate with providers in healthcare decision-making.
• Coaches and trains junior colleagues in techniques, processes, and responsibilities.

Required Qualifications

• Independent New Jersey License: LCSW, LMFT, LPCC
• Resident in the state of New Jersey
• 3+ years experience in behavioral health, social services
• 2+ years of experience with personal computers, keyboards and multi-system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint, etc.)
• Must be willing to travel as required up to 25-50% (Mileage will be reimbursed per company policy.)

Preferred Qualifications

• Bilingual
• Case Management experience
• Experience working on a multi disciplinary team

Education

• Masters degree required

Pay Range

The typical pay range for this role is:

$66,575.08 - $142,576.72

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, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 12/31/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.