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About the Role

Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Responsibilities

• Conduct comprehensive assessments of member needs and eligibility, determining approach to case resolution.
• Apply clinical judgment to reduce risk factors and address complex clinical indicators impacting care planning.
• Perform crisis intervention with members experiencing a behavioral or medical crisis and refer them to appropriate providers.
• Provide crisis follow-up to ensure members receive appropriate treatment/services.
• Interpret applicable criteria and clinical guidelines to ensure appropriate administration of benefits.
• Consult with supervisors, Medical Directors, and other programs to overcome barriers to meeting goals.
• Present cases at case conferences to obtain a multidisciplinary view for optimal outcomes.
• Identify and escalate quality of care issues through established channels.
• Influence appropriate member care by speaking with medical and behavioral health professionals.
• Utilize influencing and motivational interviewing skills to ensure maximum member engagement.
• Promote lifestyle/behavior changes to achieve optimum health.
• Provide coaching, information, and support to empower members in making independent medical and healthy lifestyle choices.
• Help members actively and knowledgeably participate with their provider in healthcare decision-making.
• Analyze utilization, self-report, and clinical data to identify comprehensive member needs.
• Develop and monitor established plans of care in collaboration with the member and their care team.
• Utilize case management and quality management processes in compliance with regulatory guidelines and company policies.
• Take and manage crisis calls.

Requirements

• Unencumbered Independent Behavioral Health clinical license in the state where they reside and work (LMHC, LCSW, LISW, LMFT, LMSW, LPC, LSW).
• 3+ years of direct clinical practice experience post masters degree (e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility).
• 3+ years minimum of Behavioral Health experience.
• Willing to work standard business hours in EST or CST.

Skills

• Advanced clinical judgment
• Critical thinking
• Assessment
• Care planning
• Provider coordination/collaboration
• Psychosocial wraparound services
• Crisis intervention
• Influencing skills
• Motivational interviewing
• Coaching
• Case management
• Discharge planning
• Managed care/utilization review
• Ability to take and manage crisis calls

Work Type

• Full time

Experience Level

• 3+ years of direct clinical practice experience post masters degree
• 3+ years minimum of Behavioral Health experience

Education Level

• Master’s degree in Behavioral/Mental Health or related field

Salary/Compensations

• $54,095.00 - $116,760.00

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• CVS Health bonus, commission or short-term incentive program

About the Company

• 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.
• Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Equal Opportunity

• Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.