Case Manager Behavioral Health (LCSW, LCPC) Field - Cook County

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 passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.Position SummaryProgram OverviewHelp us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.Family Summary/MissionFacilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements, and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.Position Summary/MissionOur Case Managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.Fundamental Components & Physical RequirementsAssessment 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 knowledgably 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 proceduresRemote Work ExpectationsThis is a remote-hybrid role; candidates must have a dedicated workspace free of interruptionsDependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.Required QualificationsMust reside in Illinois3-5 years clinical practical experience2-3 years CM, discharge planning and/or home health care coordination experienceConfidence working at home/independent thinker, using tools to collaborate and connect with teams virtuallyMust possess reliable transportation and be willing and able to travel up to 50% in Cook County and surrounding areas. Mileage is reimbursed per our company expense reimbursement policyExcellent analytical and problem-solving skillsEffective communications, organizational, and interpersonal skillsAbility to work independentlyProficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.Efficient and Effective computer skills including navigating multiple systems and keyboardingPreferred QualificationsCertified Case ManagerBilingualEducation• Master’s Degree in Behavioral/Mental Health or related fieldLicense:• LCSW or LCPC in the state of IllinoisAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$66,575.00 - $142,576.00This pay range represents the base hourly rate or base annual full-time salary