Care Plan Reviewer - Clinical Case Manager Behavioral Health

CVS Health; Ohio; Sur place; USD 61 000 - 130 000; Plein temps

Avantages offerts par ce poste

Medical insurance

Dental insurance

Vision insurance

Paid time off

Résumé du poste

CVS Health is seeking a Care Plan Reviewer (Clinical Case Manager BH) in Ohio to assess member needs across physical and behavioral health and to coordinate with providers and community resources for optimal outcomes.

You will use advanced clinical judgment, crisis intervention, and data review to develop care plans, monitor progress, and ensure quality and regulatory compliance while traveling up to 10% and working standard business hours.

Qualifications

• Active Behavioral Health license in OH (e.g., LMFT, LSW, LPC, LISW).
• Hospital, ambulatory care, or outpatient clinic/facility experience.

Responsabilités

• Assess referred member's needs/eligibility and determine approach to case resolution.
• Coordinate with medical providers and wraparound services to promote optimal outcomes.
• Apply clinical judgment to reduce risk factors and address complex indicators.
• Provide crisis intervention and follow-up for behavioral health crises.
• Monitor plans of care in collaboration with care teams and ensure regulatory compliance.

Connaissances

Case management

Communication

MS Office

Formation

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

Outils

MS Office Suite

Description du poste

We’re building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time. The Care Plan Reviewer (Clinical Case Manager BH) utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/ collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems.

Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.

Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.

Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical 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/services.

Enhancement of Medical Appropriateness and Quality of Care:

• Application and/or interpretation of 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.

Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; 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 promotes lifestyle/behavior changes to achieve optimum level of health.

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.

Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.

Monitoring, Evaluation and Documentation of Care:

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.

Must be Ohio Resident.

• Active Behavioral Health license in the state Ohio (ex: LMFT, LSW, LPC, LISW).
• hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.
• 2+ years of experience in children's mental health, child welfare, developmental disabilities, juvenile justice, or a human services or behavioral health care field, providing community-based services to children and youth, and their family/caregivers.
• 2+ years of experience in one or more of the following areas of expertise: family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development.
• Willing and able to travel up to 10% for occasional regional trainings/meetings in the state of OH as need basis. This includes travel to Columbus, OH office for quarterly yearly meetings/trainings is also expected.
• Willing to work standard business hours: Monday - Friday, 8am - 5pm.
• 1+ year(s) of experience with personal computers, keyboard, multi-systems navigation, and MS Office Suite applications.

Managed care/utilization review experience

Case management and discharge planning experience

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

Full time Pay Range

60,522.00 - $129,615.00 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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/31/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.