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Requisition Job Description

Summary :

The Clinical Case Manager, Behavioral Health/SMI is a field based role with up to 40% travel within the Miami-Dade and Monroe counties. The SMI Clinical Case Manager, is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating) for a Seriously Mentally Ill (SMI) population. The CCM, SMI, utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member behavioral and physical healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Position Responsibilities:

• Responsible for telephonic and/or face to face assessment, planning, implementing and coordinating care management activities with members to ensure that their medical and behavioral health needs are met and to enhance the member’s overall wellness.

• Develops a proactive course of action to address issues presented and facilitate short and long-term outcomes as well as identify opportunities to enhance a member’s overall health through integration.

• Through the use of clinical tools and information/data review, conducts comprehensive assessments of member’s needs and recommends an approach to case resolution by meeting needs in alignment with their benefit plan and available internal and external programs and services.

• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical and social indicators which impact care planning and resolution of member issues.

• Completes assessments that take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality and the member’s restrictions/limitations.

• Analyzes utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.

• Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health 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 and services.

• Applies and interprets 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.

• Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access.

• Using holistic approach consults with managers, medical directors and/or other physical/behavioral health support staff and providers to overcome barriers to meeting goals and objectives/

• Presents cases at case conferences/rounds to obtain multidisciplinary view in order to achieve optimal outcomes.

• Works collaboratively with the members’ interdisciplinary care team.

• 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 discern their health status and health needs based on key questions and conversation.

• 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.

• 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.

• Facilitates clinical hand offs during transitions of care.

• Reports to: Manager, Clinical Health Services

Required Qualifications

• Must be fluent in Creole

• Must reside in the Miami area

• Willing and able to travel up to 40% of their time within the Miami-Dade and Monroe counties to visit members face to face

• 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

• 2+ years of experience managing members with serious mental illness

• 2+ years of experience using crisis intervention skills

• 2+ years of experience providing care to a diverse population

• 2+ years of experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)

• Licensed mental health professional with current unencumbered license in the state of FL: Licensed Mental Health Counselor (LMHC), Licensed Marriage & Family Therapist (LMFT), PsyD, or Licensed Clinical Social Worker (LCSW)

Preferred Qualifications

• Managed care/utilization review experience

• Case management and discharge planning experience

Education Requirement

• Minimum Master’s degree in behavioral/mental health or related field required

Pay Range

The typical pay range for this role is:

$54,095.60 - $116,760.80

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 Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 01/04/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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.

We are an equal opportunity and affirmative action employer. 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.