Job Description Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members. Health service strategies, policies, and programs are comprised of utilization management, quality management, network management, clinical coverage and policies. The position requires advanced clinical judgment and critical thinking skills in order to facilitate appropriate physical, behavioral health, psychosocial wrap around services. The care manager will be responsible for, care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner. Strong assessment, writing and communication skills are required.
Fundamental Components/Job Description: The Clinical Case Manager BH is responsible for conducting face to face visits using comprehensive assessments of members enrolled in Managed Long-Term Services and Supports program (MLTSS). The care manager is responsible to coordinate and collaborate care with member/authorized representative, PCP, and any other care team participant. The care manager will attend interdisciplinary meetings and advocate on members behalf. The care manager works with member and care team to develop care plan and will authorize services within the MLTSS benefit. The care manager will also work with the member and care team to coordinate and assist with community resources. The care manager is responsible for documenting accurately and timely in the electronic health record. This position requires the care manager to use critical thinking and be able to problem solve any issues related to assigned membership. While this position is tele-work the care manager must work normal business hours. The Case Manager will also be expected, to mentor new hires, once, a level of proficiency has been attained in their role.
Required Qualifications 2 + years experience in behavioral health, social services or appropriate related field equivalent to program focus required Active and Unrestricted licensure in Social Work (LCSW or LSW) required Must be comfortable completing Field based travel to meet with Members; 50 to 75% travel required in Morris County and surrounding counties.
Preferred Qualifications Managed Care experience Case management and/or discharge planning experience
Education Master's degree or equivalent relevant experience in required areas of focus
Business Overview At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.
Internal Number: 1636495BR
About CVS Health
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.
At CVS Health, we work every day to help people on their path to better health. Never has it been more important for us to deliver on our purpose to our valued customers, patients, members, and employees. With a presence in communities across the country, CVS Health colleagues are and will continue to be a critical piece of the country’s health care solution. The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together. If you would like to learn about the actions we are taking as a company as we learn more about COVID-19 and its spread, we encourage you to visit our COVID-19 resource center at https://cvshealth.com/covid-19
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to... attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. 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. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. Please note that we only accept applications for employment via this site.
We provide reasonable accommodations to qualified individuals with disabilities. If you need to request an accommodation, a qualified interpreter, written information in other formats, translation or other services, please contact our Advice and Counsel Reasonable Accommodations team by emailing Advice and Counsel Reasonable Accommodations team or calling 877-805-9511.
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