Behavioral Health Clinical Case Manager/Southern Bluegrass Region at CVS Health

Arjay, Kentucky, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Lives within the Southern Bluegrass Region (counties: Fayette, Clark, Jessamine, Madison, Mercer, Boyle, Lincoln, Gerrard, Estill, Powell)
3-5 years of direct clinical practice experience post Master’s degree (e.g., hospital setting, ambulatory care, or outpatient clinic/facility)
Crisis intervention skills preferred
Managed care/utilization review experience preferred
Case management experience preferred

Responsibilities

Conducts comprehensive assessments of referred member’s needs/eligibility using clinical tools and data review, determining approach to case resolution by evaluating benefit plans and available programs/services
Applies clinical judgment to incorporate strategies reducing risk factors and addressing complex clinical indicators impacting care planning and member issues
Performs crisis intervention for members in behavioral health or medical crisis, refers to appropriate providers, and provides crisis follow-up to ensure treatment/services
Applies/interprets criteria, guidelines, case management plans, policies, procedures, and standards to assess benefits/needs and ensure appropriate benefit administration
Consults with supervisors, Medical Directors, and others to overcome barriers; presents cases at conferences for multidisciplinary input to achieve optimal outcomes
Identifies and escalates quality of care issues through established channels
Speaks with medical and behavioral health professionals to influence appropriate member care
Utilizes influencing/motivational interviewing skills for member engagement and to promote lifestyle/behavior changes for optimum health
Provides coaching, information, and support to empower members in independent medical/healthy lifestyle choices and participation in healthcare decision-making
Analyzes utilization, self-report, and clinical data to identify comprehensive member needs
Develops and monitors plans of care in collaboration with member and care team to meet goals
Utilizes case management and quality management processes in compliance with regulatory, accreditation guidelines, and company policies/procedures

Skills

Clinical Judgment

Case Management

Care Planning

Crisis Intervention

Behavioral Health

Assessment

Provider Coordination

Psychosocial Services

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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