Job Description

Job Description
Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate
appropriate healthcare outcomes for 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 members
needs/eligibility and recommends an approach to case
resolution and/or meeting needs by evaluating members
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 members 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 knowledgably 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
Bachelor's degree or non-licensed master level clinician
required, with either degree being in behavioral health or human services preferred (psychology, social work,
marriage and family therapy, counseling)

Preferred Qualifications
Case management and discharge planning experience
preferred Managed Care experience preferred
Microsoft Office experience preferred
LCSW / LCPC/ LPC / LMFT / LPN / RN preferred.

Education
Bachelor or masters degree prepared in human-services
related field
One (1) year of satisfactory program experience may
replace one year of college education, at least four (4)
years of experience replacing baccalaureate degree

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.