Care Plan Reviewer – Clinical Case Manager, Behavioral Health

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🔥 0 minutes ago

🐎 Kentucky, Louisiana, +2 more states – Remote

🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🏈 Ohio – Remote ⛰️ West Virginia – Remote

💵 $54.1k - $129.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔍🏥 Medical Reviewer

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• Just posted.
• Jobs at this company usually fill in 21 days.

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Conduct comprehensive assessments of referred members' needs and eligibility using clinical tools and data review • Determine case-resolution approaches by evaluating benefit plans and internal and external programs/services • Apply clinical judgment and strategies to reduce risk factors and address complex clinical indicators • Perform crisis intervention for members experiencing behavioral health or medical crises • Refer members to appropriate clinical providers and provide crisis follow-up • Apply and interpret clinical criteria, guidelines, case management plans, policies, procedures, and regulatory standards • Consult with supervisors, Medical Directors, and other programs to overcome care barriers • Present cases at multidisciplinary case conferences • Identify and escalate quality-of-care issues • Influence appropriate care through communication with medical and behavioral health professionals • Use motivational interviewing to promote member engagement and healthy behavior changes • Provide coaching, information, and support for independent medical and healthy lifestyle choices • Help members participate knowledgeably in healthcare decision-making • Analyze utilization, self-report, and clinical data to identify comprehensive member needs • Develop and monitor plans of care with members and care teams • Use case management and quality management processes in compliance with regulatory, accreditation, and company requirements

🎯 Requirements

• Must reside in OH, KY, WV, or LA • Active Behavioral Health license in the state of Ohio (e.g., LMFT, LSW, LPC, LISW); colleagues outside Ohio must obtain the required licensure within 60 days of hire • 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, human services, or behavioral health care, providing community-based services to children and youth and their families/caregivers • 2+ years of experience in 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, including quarterly meetings/trainings at the Columbus, Ohio office • Willing to work Monday–Friday, 8am–5pm • 1+ year of experience with personal computers, keyboard, multi-systems navigation, and MS Office Suite applications • Minimum Master's degree in Counseling, Social Work, or Marriage and Family Therapy

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program eligibility

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