Case Manager Behavioral Health (Field - Chinatown area) Preferred Bilingual

CVS HealthLocation Not Available

Stellenbeschreibung:

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 Summary

Help 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.

Family Summary / Mission

Facilitate 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 / Mission

Our 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 Requirements

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.
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 a 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 a 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 knowingly 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.
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 procedures.

Remote Work Expectations

This is a remote‑hybrid role; candidates must have a dedicated workspace free of interruptions.
Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

Required Qualifications

Must reside in Illinois.
3–5 years clinical practical experience.
2–3 years CM, discharge planning and/or home health care coordination experience.
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually.
Must possess reliable transportation and be willing and able to travel up to 50–75% in Southloop, Chinatown and surrounding areas. Mileage is reimbursed per our company expense reimbursement policy.
Excellent analytical and problem‑solving skills.
Effective communications, organizational, and interpersonal skills.
Ability to work independently.
Proficiency 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 keyboarding.

Preferred Qualifications

Certified Case Manager is preferred.
Bilingual in English AND Cantonese or Mandarin.

Education

Master’s Degree in Behavioral/Mental Health or related field.

License

LCSW or LCPC in the state of Illinois.

Anticipated Weekly Hours

Time Type

Full time

Pay Range

$66,575.00 – $142,576.00

The typical pay range for this role is: The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.