Clinical Case Manager- Behavioral Health -NJ

to travel up to 25 - 50% of the time within NJ as needed. Applicants must reside in New Jersey. Preference for those residing in** **North or South NJ counties (Union, Essex, Bergen, Passaic) and Southern Counties (Cape May, Cumberland, Atlantic).**Position Summary

Applies advanced clinical judgement to facilitate appropriate member physical health and behavioral healthcare. Implements strategy to assess and plan care, direct provider collaboration, and coordinate psychosocial wraparound services. Instructs the application of available resources to produce optimal, cost-effective outcomes.The most rewarding aspect of the Clinical Care Management role is evidenced by the positive outcomes of collaborative efforts between the care manager, member, and servicing providers.

• Executes comprehensive assessments of member needs and eligibility by evaluating member benefit plans and available services.
• Develops strategies to reduce risk factors and address complex clinical indicators that impact care planning and issue resolution.
• Acts as a top-level specialist to perform crisis intervention with members experiencing a behavioral health or medical crisis, refers appropriate providers, and follows up to ensure members are receiving the appropriate services.
• Adapts clinical guidelines, standardized case management procedures, and regulatory standards to needs assessments to ensure appropriate administration of benefits.
• Counsels with medial and behavioral health professionals to influence appropriate member care.
• Coaches members to make ongoing independent medical and healthy lifestyle choices, and to actively participate with providers in healthcare decision-making.
• Coaches and trains junior colleagues in techniques, processes, and responsibilities.
• Responsible to coordinate and collaborate care with member/authorized representative, PCP, and any other care team participant
• Attend interdisciplinary meetings and advocate on members behalf
• Work with the member and care team to coordinate and assist with community resources
• Documenting accurately and timely in the electronic health record
• Use critical thinking and be able to problem solve any issues related to assigned membership

Required Qualifications
A Brief Overview
Applies advanced clinical judgement to facilitate appropriate member physical health and behavioral healthcare. Implements strategy to assess and plan care, direct provider collaboration, and coordinate psychosocial wraparound services. Instructs the application of available resources to produce optimal, cost-effective outcomes.

What you will do

• Executes comprehensive assessments of member needs and eligibility by evaluating member benefit plans and available services.

• Develops strategies to reduce risk factors and address complex clinical indicators that impact care planning and issue resolution.

• Acts as a top-level specialist to perform crisis intervention with members experiencing a behavioral health or medical crisis, refers appropriate providers, and follows up to ensure members are receiving the appropriate services.

• Adapts clinical guidelines, standardized case management procedures, and regulatory standards to needs assessments to ensure appropriate administration of benefits.

• Counsels with medial and behavioral health professionals to influence appropriate member care.

• Coaches members to make ongoing independent medical and healthy lifestyle choices, and to actively participate with providers in healthcare decision-making.

• Coaches and trains junior colleagues in techniques, processes, and responsibilities.

Required Qualifications

• One of the following New Jersey Licenses is required: LCSW, LMFT, LPC

• Resident in the state of New Jersey

• 3+ years experience in behavioral health

• 2+ years of experience with personal computers, keyboards and multi-system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint, etc.)

• Must be willing to travel as required up to 25-50% (Mileage will be reimbursed per company policy.)

Preferred Qualifications

• Bilingual

• Case Management experience

• Managed Care experience

• Experience working with New Jersey Medicaid population

• Experience working on a multi disciplinary team

Education

• Masters degree required

Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$66,575.00 - $142,576.00This 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.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 03/26/2025Qualified 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 [email protected] 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.