Remote Hybrid Clinical Case Manager Behavioral Health – Central Region

CVS Health

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Job ID: 2539127BR
Category: Medicaid
Remote: Fully Remote

Job Description
The Aetna Better Health of West Virginia plan has a successful, 26+ year history of partnering with the State to provide West Virginia’s Medicaid population with top notch health care coordination and service. The plan also has been chosen to provide care coordination to complex foster care children of the state. Through a strong, localized team, an innovative care management model, and creative provider and community advocacy partnerships, Aetna Better Health of West Virginia has successfully assisted the State in achieving high quality standards and outcomes for the Medicaid population across the state. The health plan truly embodies the commitment of West Virginian’s helping West Virginian’s. At Aetna Better Health of West Virginia, you can be the very best you can be working with strong teams committed to helping our members and with opportunities for career growth. We will support you all the way!

Position Summary :
This is a full-time field teleworker position that requires West Virginia residency. Travel is required 50% of the time or more, in the Central region of WV. Field-based travel locations may include member homes, residential treatment facilities, group homes, shelters, and detention facilities. Qualified candidates must reside in Central region counties that includes: Braxton, Calhoun, Clay, Fayette, Gilmer, Kanawha, Nicholas, Roane, and Webster.

Schedule is Monday – Friday, 8am-5pm, standard business hours. No nights, weekends and no holidays. A flexible work schedule may be available after 6 months of service and with demonstrated performance and attendance.

The Clinical Care 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. This position is heavy community-based with some onsite presence at Department of Health and Human Resources (DHHR) offices.

Fundamental Components:
• Assessment of Members:
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
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 established channels.
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 health.
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.
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.
• Effective communication skills, both verbal and written.

Pay Range
The typical pay range for this role is:
Minimum: 58,760
Maximum: 125,840

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

Required Qualifications
• Must reside in WV, Central region.
• Unencumbered West Virginia (WV) Behavioral Health clinical license (LPC, LMFT, LICSW, LGSW)
• 3+ years of direct clinical practice experience post Master’s degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
• Must possess reliable transportation and be willing and able to travel in the assigned region 50% of the time or more. Mileage is reimbursed per our company expense reimbursement policy.
• 2+ years of experience with personal computers, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams)

COVID Requirements

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.

Preferred Qualifications
• Waiver experience
• Foster care experience
• Crisis intervention skills
• Managed care/utilization review experience
• Case management experience in an integrated model
• Case management and discharge planning experience.
• Certified Case Manager (CCM) certification
• Familiarity with QuickBase

• Minimum of a Master’s degree in Behavioral/Mental Health field required.

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.