Clinical Case Manager Behavioral Health

Company: Aetna Inc.
Location: Miami
Posted on: September 25, 2022

Job Description:

Job Description

This is a telework role, Monday-Friday. Standard business hours, 8:00am-5:00pm EST. No nights, no weekends and no holidays. Up to 50-75% of local travel.

Applicants must reside in Miami or Tampa FL or within a 50 mile radius of Miami. Strongly prefers candidates in Miami area or within 50 miles of it.

Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the behavioral health and medical needs of the member to facilitate the member's overall wellness.

* Staff will be imbedded in high volume facilities to facilitate the care coordination process
* Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration.
* Services strategies policies and programs are comprised of network management and clinical coverage policies.
* Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
* Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
* Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
* Reviews prior claims to address potential impact on current case management and eligibility.
* Assessments include the member's level of work capacity and related restrictions/limitations.
* Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
* Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
* Utilizes case management processes in compliance with regulatory and company policies and procedures.
* Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

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

* Must have one of the following active and unrestricted licensures: LCSW, LMHC, LMFT, LCPC or licensed Psychologist in the state of Florida.
* Minimum 4 years of clinical experience required.
* Minimum 2 years of behavioral health or psychiatric experience required.
* Willing and able to travel 50-75% of their time to meet members face to face in Miami or Tampa region in FL.

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

* Case management experience preferred.
* Coordination of Care experience preferred.
* Spanish Speaking

Education

Master degree in Behavioral health (Psychology, Counselling social work.) 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.

Keywords: Aetna Inc., Miami , Clinical Case Manager Behavioral Health, Healthcare , Miami, Florida