Clinical Case Manager Behavioral Health

CVS Health; Hackensack (NJ); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading health solutions company is seeking a Clinical Case Manager Behavioral Health to develop and implement health service strategies. This entry-level position requires strong assessment and communication skills, with responsibilities including care planning and provider collaboration. The role involves remote work and travel within Bergen County, offering a signing bonus for eligible candidates.

Benefits

Signing bonus potential up to $10,000

Qualifications

• Strong assessment, writing, and communication skills are essential.
• Advanced clinical judgment and critical thinking skills required.

Responsibilities

• Conduct face-to-face assessments for members enrolled in MLTSS and D-SNP/FIDE.
• Coordinate and collaborate with members, PCPs, and care teams.
• Develop care plans and authorize services within MLTSS/FIDE benefits.

Skills

Assessment

Communication

Critical Thinking

Education

NJ Choice Certification

Job description

Join to apply for the Clinical Case Manager Behavioral Health role at CVS Health.

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. We do this with heart, each and every day.

Position Summary

Signing bonus potential up to $10,000 for eligible external candidates with NJ Choice Certification.

Develop, implement, support, and promote health service strategies, policies, and programs that drive the delivery of quality healthcare to our members. These include utilization management, quality management, network management, and clinical coverage policies.

The role requires advanced clinical judgment and critical thinking skills to facilitate appropriate physical, behavioral health, and psychosocial wrap-around services. Responsibilities include care planning, provider collaboration, and resource utilization in a cost-effective manner. Strong assessment, writing, and communication skills are essential.

Key Responsibilities

1. Conduct face-to-face assessments for members enrolled in Managed Long-Term Services and Supports (MLTSS) and/or Dual Special Needs Programs (D-SNP/FIDE).
2. Evaluate medical needs of non-MLTSS members to promote wellness and service access, including requests for adult and pediatric medical daycare, personal care, nursing facilities, and program enrollment.
3. Complete NJ Choice Certification to maintain employment.
4. Coordinate and collaborate with members, authorized representatives, PCPs, and care teams.
5. Attend interdisciplinary meetings and advocate for members.
6. Develop care plans and authorize services within MLTSS/FIDE benefits.
7. Coordinate community resources and document accurately in electronic health records.
8. Use critical thinking to solve issues related to assigned memberships.
9. Work remotely during normal business hours and mentor new hires after proficiency is attained.
10. Travel 50-75% in Bergen and surrounding counties.

Additional Details

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Health Care Provider
• Industries: Hospitals and Health Care