Clinical Case Manager Behavioral HealthCVS Pharmacy | Lawrence, IN, US
Posted 23 days ago
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Aetna Better Health of Kansas, is committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for talent like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Aetna Better Health of Kansas members. We value diversity and are dedicated to helping you achieve your career goals.
This is a remote role open to candidates located anywhere in KS.
Currently up to 25% travel expectation depending on location, and closer to 50% -75% travel within required area once COVID restrictions are lifted.
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.
Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
Assessment of Members: 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.
Enhancement of Medical Appropriateness and Quality of Care:
– 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 knowledgeably 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.
Monitoring, Evaluation and Documentation of Care:
– 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.
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
– Minimum 1 year of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic and/or facility
– Unencumbered Behavioral Health clinical Kansas state license (LMSW, LSCSW,LCP, LMLP, LPC, LCPC, LMFT, LCMFT)
– Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm, is required.
-Willing and able to travel 50-75% of their time using their own vehicle to Douglas, Johnson and Shawnee counties KS and surrounding areas to meet members face to face.
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
– Crisis intervention skills
– Managed care experience
– Home and Community Based Services experience
– Case management and discharge planning experience
Minimum of a Master’s degree in Behavioral/Mental Health or human services field required.
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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