Care Plan Reviewer (Clinical Case Manager BH)

We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience. At CVS Health, you'll be surrounded by colleagues who care deeply, innovate with purpose, and prioritize safety and quality in everything they do.

Job Summary: The Care Plan Reviewer (Clinical Case Manager BH) uses advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination, and coordination of psychosocial wraparound services.

Key Responsibilities:

• Conduct comprehensive assessments of referred members' needs and eligibility using clinical tools and information/data review.
• Apply clinical judgment to incorporate strategies designed to reduce risk factors and address complex clinical indicators impacting care planning and resolution of member issues.
• Perform crisis intervention with members experiencing a behavioral health or medical crisis and refer them to appropriate clinical providers.
• Provide crisis follow-up to members to ensure they receive appropriate treatment/services.
• Enhance medical appropriateness and quality of care by applying and interpreting applicable criteria and clinical guidelines.
• Consult with supervisors, Medical Directors, and other programs to overcome barriers to meeting goals and objectives.
• Identify and escalate quality of care issues through established channels.
• Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes.
• Provide coaching, information, and support to empower members to make ongoing independent medical and healthy lifestyle choices.

Requirements:

• Active Behavioral Health license in Ohio (e.g., LMFT, LSW, LPC, LISW).
• 3+ years of direct clinical practice experience post-Master's degree.
• 2+ years of experience in children's mental health, child welfare, developmental disabilities, juvenile justice, or a human services or behavioral healthcare field.
• 2+ years of experience in one or more areas of expertise: family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development.
• Willing and able to travel up to 10% for occasional regional trainings/meetings in Ohio.
• Willing to work standard business hours: Monday - Friday, 8am - 5pm.
• 1+ year of experience with personal computers, keyboard, multi-systems navigation, and MS Office Suite applications.

Preferred Qualifications:

• Independent clinical license preferred: LPCC, IMFT, or LISW.
• Managed care/utilization review experience.
• Case management and discharge planning experience.

Education:

• Minimum of a Master's degree in Counseling, Social Work, or Marriage and Family Therapy.

Salary Range: $54,095.00 - $129,615.00

Benefits: Comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.