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

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven 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 Aetna’s Long-Term Services and Supports (LTSS) team. The requirements is for candidates to hold an Illinois Registered Nursing License, and travel 50-75% of the time to meet with members face to face.

This is a field-based position out of Southwest, West, and Central Chicago with preference for those residing in the following zip codes: 60601, 60605, 60606, 60607, 60608, 60609, 60611, 60612, 60616, 60623, 60624, 60632, 60638, 60644, 60653, 60804, 60651, 60642, 60622, 60654, 60647, 60639.

Position Summary

The Clinical Case Manager, Behavioral Health, is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). The CCM, BH, utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Position Responsibilities: 

+ Responsible for face to face and/or telephonic assessment, planning, implementing and coordinating care management activities with members to ensure that their medical and behavioral health needs are met and to enhance the member’s overall wellness.

+ Develops a proactive course of action to address issues presented and facilitate short and long-term outcomes as well as identify opportunities to enhance a member’s overall health through integration.

+ Through the use of clinical tools and information/data review, conducts comprehensive assessments of member’s needs and recommends an approach to case resolution by meeting needs in alignment with their benefit plan and available internal and external programs and services.

+ Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical and social indicators which impact care planning and resolution of member issues.

+ Completes assessments that take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality and the member’s restrictions/limitations.

+ Analyzes utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.

+ Applies and interprets applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.

+ Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access.

+ Using holistic approach consults with managers, medical directors and/or other physical/behavioral health support staff and providers to overcome barriers to meeting goals and objectives/

+ Presents cases at case conferences/rounds to obtain multidisciplinary view in order to achieve optimal outcomes.

+ Works collaboratively with the members’ interdisciplinary care team.

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

+ Ability to speak to medical and behavioral health professionals to influence appropriate member care.

+ Utilizes influencing/motivational interviewing skills to ensure maximum member  engagement and discern their health status and health needs based on key questions and   conversation.

+ 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.

+ In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals.

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

+ Facilitates clinical hand offs during transitions of care.

Required Qualifications

+ One of the following active Illinois clinical license is required- **LCSW, LCPC, LMFT**

+ Minimum of 2 years of experience in behavioral health or social services field preferably working with individuals living with complex medical needs and disabilities.

+ Must reside in Southwest, West, or Central Chicago IL Area (Applicable Zip Codes: 60601, 60605, 60606, 60607, 60608, 60609, 60611, 60612, 60616, 60623, 60624, 60632, 60638, 60644, 60653, 60804, 60651, 60642, 60622, 60654, 60647, 60639)

+ Must possess reliable transportation and be willing and able to travel 50-75% of the time to meet members face to face in Southwest, West, Central Chicago and surrounding areas. Mileage is reimbursed per our company expense reimbursement policy.

Preferred Qualifications

+ Case Management and Discharge Planning experience preferred

+ Managed Care experience preferred

+ Microsoft Office experience preferred

Education

+ Masters degree required, with either degree being in behavioral health or human services preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$66,575.00 - $142,576.00

This 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 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** .

+ **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/benefits

We anticipate the application window for this opening will close on: 05/17/2025

Qualified 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.

We are an equal opportunity and affirmative action employer. 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.