Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand with heart at its center our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Fully remote in USA.

Shift: Monday-Friday standard business hours.

No nights, no weekends, no holidays and no on call.

The Clinical Case Manager 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.

• The telephonic clinical case manager applies clinical judgment and incorporates the strategies designed to reduce risk factors for readmission and addresses complex clinical indicators which impact care planning and resolution of member issues.
• Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs.
• Using clinical tools and information/data review, conducts comprehensive assessments of members needs and determines approach to case resolution and meeting needs by evaluating members benefit plan and available internal and external programs and services with intent of reducing readmissions
• Will document in healthcare clinical systems to support ACA Individual Family Plan population.
• Provides BH consultation and collaboration with Aetna partners and other Shared Services with active participation in Interdisciplinary Care Team case conferences.
• Active participation in team activities focused on program development. Innovative thinking expected.
• This is a telephonic remote position, that is member-facing role with primary responsibility that includes member outreaches and computer documentation.
• Assist members completing medication reconciliation, provider referrals for aftercare and locating community based behavioral health resources as well as locating resources for social determinants of health.

Required Qualifications

3+ years of direct clinical practice experience

Unrestricted license in state of residence (ex: LPC, LMFT, LCSW, LMHC, LCMHC, LICSW, LISW, Clinical Psychologist.), or active RN with extensive behavioral health background (BSN preferred)

Must be proficient with computer with general knowledge of Microsoft Word, Excel, Teams, Outlook

Confidence working at home/independent thinker, using tools to collaborate and connect with teamsvirtually

Preferred Qualifications

Bilingual Spanish strongly

Crisis intervention skills

Managed care or utilization review experience preferred

Case management and discharge planning experience

• Substance use Disorder experience

Education

Masters degree in social work or Counseling required OR RN with 3 years of behavioral health experience.

Additional Requirements

Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps to ensure sufficient speed to adequately perform work duties. Some candidates may be eligible for partial reimbursement of the cost of residential broadband service.

Pay Range

The typical pay range for this role is:

$60,522.80 - $129,600.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. 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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Companys 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.