Behavioral Health Care Plan Reviewer

CVS Health Corporation; Kentucky; Hybrid; USD 61,000 - 130,000; Full time

Job summary

CVS Health Corporation seeks a Care Plan Reviewer (Clinical Case Manager BH) to support behavioral health through assessment reviews and care planning, coordinating with care coordinators to promote effective, cost-efficient outcomes. The OhioRISE program focuses on children with complex needs and requires strong clinical judgment and collaboration with MCOs and ODM.

Required licensing in Ohio and 2+ years in related fields, plus willingness to travel up to 10%.

Qualifications

• Unencumbered Behavioral Health license in Ohio (LMFT, LSW, LPC).
• 2+ years in children's mental health or related human services field.
• Experience in family systems, case management or related areas.
• Willingness to travel up to 10% with a personal vehicle.

Responsibilities

• Provide clinical consultation for members with complex needs across child-serving systems.
• Assess and review Care Plans and Crisis/Safety Plans using clinical judgment.
• Coordinate with supervisors and Medical Directors to overcome barriers and optimize outcomes.
• Explain and apply criteria, guidelines, and regulatory standards during reviews.

Skills

Clinical consultation

Cultural competence

Critical thinking

Communication

Travel readiness

Education

Master's degree in Counseling, Social Work, or Marriage and Family Therapy

Tools

MS Office Suite

Job description

CVS Health Corporation seeks a Care Plan Reviewer (Clinical Case Manager BH) to support behavioral health through assessment reviews and care planning, coordinating with care coordinators to promote effective, cost-efficient outcomes. The OhioRISE program focuses on children with complex needs and requires strong clinical judgment and collaboration with MCOs and ODM.

Required licensing in Ohio and 2+ years in related fields, plus willingness to travel up to 10%.