Clinical Case Manager Behavioral Health- Field at CVS Health

Schaumburg, Illinois, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Clinical licensure
Minimum two years experience working with children living with special needs or children in foster care
Willing and able to travel up to 50-75% of their time to meet members face to face within one hour of their location
Reliable transportation required; mileage is reimbursed per company expense reimbursement policy

Responsibilities

Executes evaluation of member needs and benefit plan eligibility and facilitates member transition to the organization's programs and plans
Applies advanced clinical judgement to incorporate strategies designed to reduce risk factors and barriers, and to address complex health indicators that impact care planning and resolution of member issues
Handles reviews of prior claims to address potential impact on current case management and eligibility
Creates a holistic approach to assess the need for referrals to clinical resources and to assist in determining functionality
Ensures case management processes follow organization and regulatory requirements
Implements systems to maximize member engagement, discern health status and needs, and to assess member levels of work capacity and restrictions
Coaches and trains junior colleagues in techniques, processes, and responsibilities

Skills

Case Management

Behavioral Health

Clinical Judgement

Care Coordination

Member Engagement

Health Assessment

Risk Factor Reduction

Claims Review

Referral Management

Regulatory Compliance

Telework

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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