Clinical Case Manager Behavioral Health - Monmouth County

Hispanic Alliance for Career Enhancement; New Jersey; Remote; USD 72,000 - 156,000; Full time

Job summary

A leading health solutions company is seeking a Clinical Case Manager BH to develop and promote healthcare strategies. This role involves significant travel within New Jersey, requiring strong clinical judgment and communication skills, along with a Master's degree in Behavioral Health.

Benefits

Comprehensive medical plans

401(k) plan

Employee stock purchase

Flexible schedules

Tuition assistance

Qualifications

• Must be a Licensed Clinical Social Worker or Licensed Social Worker in NJ.
• At least 2 years of Behavioral Health experience required.
• Successful completion of NJ Choice certification with a score of 80% or higher.

Responsibilities

• Develop and implement health service strategies and policies.
• Conduct face-to-face assessments and coordinate care plans.
• Mentor new hires and maintain accurate documentation.

Skills

Assessment

Communication

Critical Thinking

Problem Solving

Education

Master's Degree in a Behavioral Health field

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.

Position Summary

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

This is a work-from-home flexible position with up to 75% travel requirements throughout Monmouth, Ocean, and surrounding counties, New Jersey.

Standard working hours: Monday - Friday, 8-5 pm EST.

Job description

Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members. These include utilization management, quality management, network management, clinical coverage, and policies. The position requires advanced clinical judgment and critical thinking skills to facilitate appropriate physical, behavioral health, and psychosocial wrap-around services. The care manager will be responsible for care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner. Strong assessment, writing, and communication skills are required.

Fundamental Components/Job Description:

The Clinical Case Manager BH conducts face-to-face visits using comprehensive assessments of members enrolled in Managed Long-Term Services and Supports (MLTSS) and/or Dual Special Needs Program (D-SNP/FIDE). Responsibilities also include face-to-face assessments with non-MLTSS members to evaluate medical needs, facilitate overall wellness, and help members obtain necessary services such as adult and pediatric medical daycare, personal care assistance, nursing facility requests, personal preference programs, and MLTSS enrollment. Successful completion of company-sponsored NJ Choice Certification is a requirement for continued employment. The care manager coordinates and collaborates with members, authorized representatives, PCPs, and other care team participants, attending interdisciplinary meetings and advocating on behalf of members. They develop care plans, authorize services within the MLTSS/FIDE benefits, and coordinate community resources. Accurate and timely documentation in the electronic health record is essential. This role requires critical thinking and problem-solving skills related to assigned memberships. While primarily telework, the care manager must work during normal business hours. Mentoring new hires is also expected once proficiency is attained. Travel of 50-75% in Monmouth, Ocean, and surrounding counties is required.

Required Qualifications

• Must reside in Monmouth County
• Willing and able to travel up to 75% in Monmouth, Ocean County, and surrounding areas
• Reliable transportation; mileage reimbursed per company policy
• Licensed Clinical Social Worker or Licensed Social Worker in NJ
• At least 2 years of Behavioral Health experience
• Successful completion of NJ Choice certification (exam score of 80% or higher, plus training modules and field mentoring)

Preferred Qualifications

• Case management and/or discharge planning experience
• Managed Care experience
• Crisis intervention skills
• LTSS experience
• Geriatric case management background

Education

• Master's Degree in a Behavioral Health field required

Additional Details

Anticipated weekly hours: 40
Time type: Full-time
Pay range: $72,627 - $155,538, depending on experience, education, and location. The role is eligible for bonuses, commissions, or incentives.

CVS Health offers comprehensive benefits, including medical plans, 401(k), employee stock purchase, wellness programs, paid time off, flexible schedules, family leave, dependent care resources, tuition assistance, and more. For details, visit https://jobs.cvshealth.com/us/en/benefits.

Application window closes on 05/30/2025. CVS Health is an equal opportunity employer and complies with all applicable laws regarding vaccination and reasonable accommodations.