Job ID: 2541109BR
Remote: Fully Remote
Position Summary :
Hours for this position are Monday-Friday 8:00am – 5:00pm EST.
Applicants must reside in Northern Virginia and be willing and able to travel 25-40% of the time in the assigned region. Mileage is reimbursed per our company expense
reimbursement policy .
The Clinical Case Manager BH 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.
• Assessment of Members:
o Conducts face-to-face member visits.
o 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
o 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.
o 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.
o Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
• Enhancement of Medical Appropriateness and Quality of Care:
o 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.
o 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.
o Identifies and escalates quality of care issues through
o Ability to speak to medical and behavioral health
professionals to influence appropriate member care.
o Utilizes motivational interviewing skills to ensure
maximum member engagement and promotes
lifestyle/behavior changes to achieve optimum level of
o Provides coaching, information and support to empower the member to make ongoing independent medical and/or
healthy lifestyle choices.
o Helps member actively and knowledgably participate with
their provider in healthcare decision-making.
o 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:
o In collaboration with the member and their care team
develops and monitors established plans of care to meet
the member’s goals.
o Utilizes case management and quality management
processes in compliance with regulatory and accreditation
guidelines and company policies and procedures.
The typical pay range for this role is:
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 Company’s 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
• Registered Nurse with current unrestricted Virginia (VA)
license or VA ”multi-state privilege” license
• 5+ years of clinical practice experience.
• 1+ year(s) of clinical nursing experience with Behavioral Health/Serious Mental Illness/Substance Use Disorders members
• Must reside in Northern Virginia.
• Must possess reliable transportation and be willing and
able to travel in the assigned region 25-40% of the time.
Mileage is reimbursed per our company expense
• 2+ years’ experience with personal computer, keyboard,
mouse, multi-system navigation; and MS Office Suite
applications (Outlook, Word, Excel, SharePoint).
COVID-19 Vaccination Requirement
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.
• Crisis intervention skills
• Medicaid experience
• Managed care experience
• Case management and discharge planning
• Experience with Substance Use Disorders
• Diploma RN or Associate degree in Nursing is required.
• BSN degree is preferred.
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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