Job Details

Bilingual Clinical Case Manager Behavioral Health

Company name
CVS Health.

Location
Downers Grove, IL, United States

Employment Type
Full-Time

Industry
Healthcare, Bilingual, Disability, Case Management, Manager

Posted on
Nov 10, 2022

Valid Through
Feb 23, 2023

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Job Description

This role is work at home anywhere in the country.

Monday-Friday 8am-5pm CST. One late day/night a week. No weekends

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.

Ability to take and manage crisis calls

Assessment 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 procedures.

Pay Range

The typical pay range for this role is:

Minimum: 55,300

Maximum: 118,900

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

- Bilingual Spanish-speaking

- Unencumbered Independent Behavioral Health clinical license in the state where they work

- 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

Preferred Qualifications

-Crisis intervention skills preferred

-Motivational Interviewing skills preferred

-Case management and discharge planning experience preferred

Education

Minimum of a Master's degree in Behavioral/Mental Health or related field

Business Overview

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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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