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CVS Health

Runs pharmacies, health plans and clinics

Clinical Case Manager - Behavioral Health

Case Management & AdvocacyConfirmed live in the last 24 hours
Full-timeMichigan, USA

About the Job

Requirements

  • Minimum experience in medical social work or case management is required; no number of years is specified.
  • Must comply with all state requirements in the state where job duties are performed.
  • Must be willing and able to travel 25%–50% of the time in Wayne and Macomb Counties; reliable transportation is required. Mileage is reimbursed under the company expense reimbursement policy.
  • Basic awareness of problem-solving and decision-making skills is required.
  • Basic awareness of digital literacy skills is required.
  • Basic knowledge of medical terminology is required.
  • Must be able to deal tactfully with customers and the community.
  • Must be able to handle sensitive information ethically and responsibly.
  • Must be able to consider the relative costs and benefits of potential actions to choose the most appropriate option.
  • Must be able to function in a clinical setting with diverse cultural dynamics among clinical staff and patients.
  • A master's degree in social work is required as required by state law.
  • LMSW is required.

Responsibilities

  • Coordinate care for members with long-term rehabilitation or psychosocial needs to prevent exacerbations, readmissions, or placement into custodial care.
  • Implement and coordinate case management, psychosocial, and quality-of-life activities across the continuum of care, including consultant referrals, home-care visits, community resources, and alternative levels of care.
  • Develop and carry out strategies to coordinate and integrate acute and long-term care services for members in case and disease management.
  • Provide psychosocial interventions through resource identification, program development, and other means.
  • Manage members with acute or chronic conditions, focusing case management activities on quality of care, compliance, outcomes, and cost reduction for individuals and communities.
  • Conduct initial and periodic assessments of members enrolled in Long-Term Care, case management, or disease management programs to determine their course of treatment.
  • Apply case management concepts, principles, and strategies to develop individualized case plans for enrolled members at risk of poor outcomes.
  • Communicate updates and facilitate discussion with providers, primary care physicians, Medical Directors, pharmacists, and care management staff about patient status, internally and externally.
  • Identify opportunities to ensure members receive necessary care allowed under their benefit plans in home or community settings.
  • Provide information, resources, and education on social issues, mental health, and available services to raise awareness and empower individuals and communities.
  • Develop programs to reduce admissions for acute and chronic members, increase community integration, and improve health outcomes for enrolled patients and other individuals.
  • Coach junior colleagues in social-work techniques, processes, and responsibilities.
  • Collaborate with community members, organizations, and policymakers to create opportunities for clients, address community issues, or raise awareness of specific issues.

Desired Qualifications

  • Behavioral health experience is preferred.
  • Bilingual ability in Spanish or Arabic is preferred.

About the Company

CVS Health

Runs pharmacies, health plans and clinics

CVS Health runs pharmacies, health insurance plans and medical clinics for individuals, employers and government programs across the United States. Its businesses include CVS Pharmacy, the Aetna insurer and Caremark, which manages prescription coverage and negotiates drug prices for health plans. Patients fill prescriptions in stores or by mail and receive care through walk-in clinics, primary care centers and home visits. The company earns money from prescription sales, insurance premiums, plan administration fees and clinical services, combining coverage with places to obtain treatment. Its first store opened in 1963, and its headquarters are in Woonsocket, Rhode Island.

Company size
10,001+
Company stage
IPO
Headquarters
Woonsocket, Rhode Island
Founded
1963

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