Clinical Case Manager: Care Coordination & Crisis Support

Preferra Insurance; North Olmsted (OH); Hybrid; USD 61,000 - 130,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Bonus eligibility

Job summary

CVS Health in the United States seeks a clinical professional to assess and coordinate member health and behavioral health needs, applying advanced clinical judgment, care planning and provider collaboration to optimize outcomes.

The role emphasizes crisis intervention, care coordination, and utilization management, with a strong benefits package and a 40-hour weekly schedule in a full-time Ohio-based position.

Qualifications

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

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.

Skills

Crisis intervention

Case management

Utilization review

Discharge planning

Assessment skills

Clinical collaboration

Education

Master's degree in Behavioral/Mental Health or related field

Unencumbered Behavioral Health clinical license in the state

Job description

CVS Health in the United States seeks a clinical professional to assess and coordinate member health and behavioral health needs, applying advanced clinical judgment, care planning and provider collaboration to optimize outcomes.

The role emphasizes crisis intervention, care coordination, and utilization management, with a strong benefits package and a 40-hour weekly schedule in a full-time Ohio-based position.