Behavioral Health Case Manager (Medicare/Medicaid)

Preferra Insurance; Oak Park (IL); Hybrid; USD 67,000 - 143,000; Full time

Job summary

CVS Health in Illinois is seeking a licensed Case Manager to join our Aetna team supporting dual eligible populations. You will assess needs, coordinate care with providers, and advocate for services to improve wellness and timely return to work.

The role requires 3-5 years clinical experience, CM/discharge planning, and ability to work from home with virtual collaboration; travel up to 50-75% in Chicago areas is expected. A Master's in Behavioral/Mental Health or related field is preferred.

Qualifications

• Must reside in Illinois.
• 3-5 years clinical practical experience
• 2-3 years CM, discharge planning and/or home health care coordination experience
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
• Must possess reliable transportation and be willing and able to travel up to 50-75% in Southloop, Chinatown and surrounding areas. Mileage is reimbursed per our company expense reimbursement policy
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills
• Ability to work independently
• Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
• Efficient and Effective computer skills including navigating multiple systems and keyboarding

Responsibilities

• Assess referred members' needs/eligibility and plan case resolution.
• Apply clinical guidelines to ensure appropriate benefits administration.
• Coordinate care with Medical Directors and other programs for optimal outcomes.
• Identify and escalate quality of care issues.
• Provide coaching, information and support to empower members’ medical decisions.
• Develop and monitor plans of care with the care team.

Skills

Analytical skills

Problem-solving

Communication skills

Organizational skills

Interpersonal skills

Independent work

Education

Master's degree in Behavioral/Mental Health or related field

Tools

MS Word

Excel

Outlook

PowerPoint

Proprietary applications

Job description

CVS Health in Illinois is seeking a licensed Case Manager to join our Aetna team supporting dual eligible populations. You will assess needs, coordinate care with providers, and advocate for services to improve wellness and timely return to work.

The role requires 3-5 years clinical experience, CM/discharge planning, and ability to work from home with virtual collaboration; travel up to 50-75% in Chicago areas is expected. A Master's in Behavioral/Mental Health or related field is preferred.