Clinical Case Manager Behavioral Health Lcsw

Aetna Inc. Lockport , IL 60441

Posted 3 weeks ago

Job Description:

Travel Required, 50 - 75% in DuPage County, Will or Northwest Cook County IL

As a Clinical Case Manager you will facilitate appropriate healthcare outcomes for our members by providing care coordination, support and education for members through the use of care management tools and resources.

Evaluation of Members:

  • Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.

  • Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.

  • Coordinates and implements assigned care plan activities and monitors care plan progress.

Enhancement of Medical Appropriateness and Quality of Care:

  • Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.

  • Identifies and escalates quality of care issues through established channels.

  • Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.

  • Utilizes influencing/ motivational interviewing skills to

ensure maximum member engagement and promote

lifestyle/behavior changes to achieve optimum level of

health.

  • Provides coaching, information and support to

empower the member to make ongoing independent

medical and/or healthy lifestyle choices.

  • Helps member actively and knowledgeably participate with their provider in healthcare decision-making.

Monitoring, Evaluation and Documentation of Care:

  • Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

2 years experience in behavioral health, social services or

appropriate related field equivalent to program focus

required.

Unrestricted licenure in the state of IL (LCSW, LCPC) required

Licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work,

marriage and family therapy, counseling)

Travel Required, 50 - 75% in DuPage County, Will or Northwest Cook County IL and surrounding areas

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

Case management and discharge planning experience

preferred

Managed Care experience preferred

Microsoft Office experience preferred

Education

Bachelors preferred or Licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work,

marriage and family therapy, counseling)

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. 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.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Medical Field Case Manager (Bilingual)

Coventry

Posted 2 months ago

VIEW JOBS 8/25/2021 12:00:00 AM 2021-11-23T00:00 Company Overview Mitchell, Genex and Coventry With Mitchell, Genex and Coventry now one organization, we've dramatically expanded our ability to deliver innovative services and technologies to our customers. We've also seen career opportunities within our combined organization grow. Each part of our organization helps people recover after a challenging event in their lives. Mitchell delivers trusted software and services to the property & casualty claims, collision repair and risk management industries with technology-enabled solutions that simplify claims handling, repair processes and pharmacy transactions. Genex helps injured workers return to their jobs in a safe and efficient manner through compassionate case management, reducing health care costs and disability expenses for our customers. Coventry offers the nation's largest and most diverse set of provider and ancillary networks focused on improving total overall outcomes. Together, we bring a complete set of proven capabilities for our partners who require more than one-dimensional solutions. We combine innovative technology, insightful analytics and deep expertise to help them reach their ultimate goal-restoring lives. Job Description This is a full-time, remote position with regular local travel (80%) required in Southwest Chicago, IL and surrounding areas (Lockport, Ottawa, etc). The Field Case Manager is responsible for assessment, planning, coordination, implementation and evaluation of injured/disabled individuals involved in the medical case management process. Working as an intermediary between carriers, attorneys, medical care providers, employers and employees, you will closely monitor the progress of the injured worker and report results back to the employer and insurance carrier. This will ensure appropriate and cost-effective healthcare services leading to a medically rehabilitated individual who is ready to return to an optimal level of work and functioning. This position requires frequent driving and is considered a "field" position. * Job duties are performed in home office and out in the field. Driving is required approximately 80% of the time. * Using clinical/nursing skills to help coordinate the individual's treatment program while maximizing cost containment. * Serving as an intermediary to interpret and educate the individual on his/her disability, and the treatment plan established by the case manager, physicians, and therapists. * Facilitate treatment between providers and worker. * Resource for claims personnel when needing providers in certain locales. * Partner with employers determining modified work. * Accurate and quality documentation meeting Best Practices timeframes. * Reporting billing hours in accordance with case activity and billing practices. * Following specific account instructions. * Demonstrates a level of professionalism within the work place and in dealing with injured workers reflects positively on the company as a whole. Qualifications * Current and active nursing license in the State of IL. You will be responsible for managing an average of 20-28 cases per month. A clinical background related to trauma, neurological, orthopedic, home health or occupational health nursing is required. * Worker's compensation experience is preferred * 2+ Years clinical nursing experience * Must have excellent time management and organizational skills. * Written Abilities: Proficient grammar, sentence structure and written communication skills are required. * Technical Experience: Knowledge of basic computer skills including Excel, Word, and Outlook Email is required. You will also need direct access to the internet. * Bilingual Spanish/English required * Licenses or Certifications: Current, unencumbered Registered Nurse license in the resident state; CCM, COHN preferred, or able to sit for exam within two years of employment. Must have local unencumbered driver's license and proof of automobile insurance. * Location: Remote, home office. Benefits We're committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. The Company is an equal opportunity employer, values the diversity of our workforce and the knowledge of our people. The Company does not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law. #LI-CC2 #COV Coventry Lockport IL

Clinical Case Manager Behavioral Health Lcsw

Aetna Inc.