Clinical Case Manager Behavioral Health Field - Hamilton Butler Warren or Clermont County OH

At CVS Health were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nations leading health solutions company we reach millions of Americans through our local presence digital channels and more than 300000 purposedriven colleagues caring for people where when and how they choose in a way that is uniquely more connected more convenient and more compassionate. And we do it all with heart each and every day.

This Clinical Case Manager Behavioral Health position is with My Care of Ohio and is a field based position. Candidates from Ohio are welcome to apply however requirement is for candidates must have a Licensed Independent Social Worker (LISW) for Ohio.

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 costeffective 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 toplevel 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 decisionmaking.
• Coaches and trains junior colleagues in techniques processes and responsibilities.
• Basic awareness of problem solving and decision making skills

Position Summary

My Care of Ohio hiring for care management in one of our counties we serve. The applicant must reside in Butler Clermont Hamilton or Warren County in Ohio. We are seeking selfmotivated energetic detail oriented highly organized techsavvy Licensed Independent Social Worker to join our Case Management team. This opportunity offers a competitive salary and full benefits. Our organization promotes autonomy through a MondayFriday working schedule paid holidays and flexibility as you coordinate the care of your members.

Case Manager BH is responsible for telephonically and/or face to face assessing planning implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the members overall wellness. Develops a proactive course of action to address issues presented to enhance the short and longterm outcomes as well as opportunities to enhance a members overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies. Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing planning implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the members overall wellness. Using clinical tools and information/data review conducts an evaluation of members 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 comorbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the members level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in g 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.

Required Qualifications

• Candidate must reside in Hamilton Butler Warren or Clermont County OH or within commutable distance (close to county line and member homes)
• Must be willing and able to travel up to 5075 of the time in Hamilton Butler Warren or Clermont County OH (Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy)
• Active and good standing Licensed Independent Social Worker (LISW) for Ohio
• 3 years of behavioral health or social work experience

Preferred Qualifications

• Case management experience
• Community social work experience
• Computer skills (Microsoft Office such as: Word Excel and Outlook)

Education

• Masters Degree in Social Work

License

• Active and good standing Licensed Independent Social Worker (LISW) for Ohio

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual fulltime 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 shortterm 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 people

We 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.

• Nocost 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 anticipate the application window for this opening will close on: 05/16/2025

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