Clinical Case Manager - Behavioral Health

Hispanic Alliance for Career Enhancement; Downers Grove (IL); Hybrid; USD 66,000 - 143,000; Full time

Job summary

A leading health solutions company seeks a Clinical Care Coordinator to utilize advanced clinical judgment in facilitating member healthcare. The role involves assessments, care planning, and provider coordination to ensure effective resource utilization and optimal outcomes. The position requires a Master's degree and an active clinical license in Illinois, with potential travel within Cook County. Join a diverse team committed to transforming healthcare.

Benefits

Medical plans

401(k)

Stock purchase plans

Wellness programs

Paid time off

Flexible schedules

Qualifications

• Minimum of 2 years of direct clinical practice experience.
• Active and unrestricted Behavioral Health clinical license (LCSW or LCPC) in Illinois.

Responsibilities

• Conduct comprehensive assessments of referred members' needs.
• Develop and monitor care plans with members and care teams.
• Communicate effectively with medical and behavioral health professionals.

Skills

Crisis intervention skills

Clinical judgment

Motivational interviewing

Education

Master's degree

Tools

MS Office

Job description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues — caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day.

Work at home with requirement to reside in Illinois. Preference for those residing in Cook County or surrounding areas.

Potential for up to 15% of travel for occasional face-to-face visits with members and travel to Downers Grove/Chicago office for meetings.

Monday - Friday 8:00 am - 5:00 pm.

The role utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment, care planning, provider coordination, and psychosocial wraparound services to promote effective resource utilization and optimal, cost-effective outcomes.

Assessment of Members:

1. Conduct comprehensive assessments of referred members' needs/eligibility using clinical tools and data review, determining approach based on benefit plans and available programs/services.
2. Apply clinical judgment to strategies aimed at reducing risk factors and addressing complex indicators impacting care planning.
3. Perform crisis intervention for members experiencing behavioral health or medical crises and refer to appropriate providers for assessment and treatment.
4. Provide crisis follow-up to ensure members receive appropriate treatment/services.

Enhancement of Medical Appropriateness and Quality of Care:

1. Interpret applicable criteria, guidelines, and policies to assess benefits and member needs, ensuring proper benefit administration.
2. Consult with supervisors, Medical Directors, and other programs to overcome barriers and present cases at case conferences for multidisciplinary insights.
3. Identify and escalate quality of care issues through established channels.
4. Communicate effectively with medical and behavioral health professionals to influence member care.
5. Utilize motivational interviewing to maximize member engagement and promote lifestyle/behavior changes.
6. Empower members with coaching and information for independent health decisions.
7. Facilitate active participation of members with providers in healthcare decisions.
8. Analyze utilization, self-report, and clinical data to identify comprehensive member needs.

Monitoring, Evaluation, and Documentation of Care:

1. Develop and monitor care plans with members and care teams to meet goals.
2. Use case and quality management processes in compliance with regulations and policies.

Required Qualifications

• Minimum of 2 years of direct clinical practice experience (e.g., hospital, ambulatory care, outpatient clinic).
• Active and unrestricted Behavioral Health clinical license (LCSW or LCPC) in Illinois.
• Willingness and ability to travel within Cook County and surrounding areas for face-to-face meetings.
• Reliable transportation; mileage reimbursed.
• Proficiency with computers, MS Office, and navigating multiple applications.

Preferred Qualifications

• Crisis intervention skills.
• Managed care/utilization review experience.
• Case management and discharge planning experience.

Education

Master's degree required.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

$66,575.00 - $142,576.00

This range reflects base salary; actual offers depend on experience, education, location, and other factors. Eligible for bonuses or incentives.

We value diversity and are committed to creating an inclusive environment.

Benefits include medical plans, 401(k), stock purchase plans, wellness programs, paid time off, flexible schedules, and more. For details, visit our benefits page.

Application deadline: 05/09/2025.

Qualified applicants with arrest or conviction records will be considered per applicable laws.