Clinical Case Manager Behavioral Health

4004 Aetna Medicaid Administrators; Kentucky; Hybrid; USD 78,000 - 130,000; Full time

Job summary

4004 Aetna Medicaid Administrators in Kentucky seeks a clinical case manager to apply advanced clinical judgment to assess member needs, plan care, and coordinate behavioral health and medical services for cost‑effective outcomes.

You will conduct comprehensive assessments, support crisis intervention, collaborate with care teams, and ensure compliance with regulatory standards while guiding members toward appropriate benefits and services.

Qualifications

• 3-5 years of direct clinical practice experience post master’s degree.
• Crisis intervention skills preferred.
• Managed care / utilization review experience preferred.
• Case management and discharge planning experience preferred.

Responsibilities

• Conduct comprehensive assessments of member needs and review benefits to determine appropriate care.
• Apply clinical judgment to reduce risk factors and guide care planning.
• Perform crisis intervention and refer to clinical providers as needed.
• Provide crisis follow-up to ensure continued appropriate treatment.
• Assess benefits and/or member needs to ensure proper administration of benefits.
• Collaborate with supervisors and care teams to overcome barriers and achieve goals.
• Identify and escalate quality of care issues through established channels.
• Engage with medical/behavioral health professionals to influence member care.
• Use motivational interviewing to boost member engagement and healthy lifestyle changes.
• Support members in making informed medical and lifestyle decisions.
• Help members participate actively with their providers in decision-making.
• Analyze utilization and data to identify member needs and monitor plans of care.

Skills

Crisis intervention

Discharge planning

Managed care / utilization review

Clinical judgment

Care coordination

Education

Master's degree in Behavioral Health or related field

Unencumbered Behavioral Health license (state)

Job description

Position Summary

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.

Position Responsibilities

• 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.
• 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; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes.
• 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.
• 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.

Required Qualifications

Educational and Experience Requirements:

• 3-5 years of direct clinical practice experience post master’s degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.
• Crisis intervention skills preferred.
• Managed care/utilization review experience preferred.
• Case management and discharge planning experience preferred.

License/Credential Requirements

• Minimum of a Master's degree in Behavioral/Mental Health or related field.
• Unencumbered Behavioral Health clinical license in the state where they work.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $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. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. 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 people fuel our future. 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. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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.

Our Work Experience

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self‑disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.