Clinical Case Manager Behavioral Health - Work at Home - NY

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Behavioral Health Care Manager is responsible for coordinating, assessing, planning, and managing services for members with behavioral health, medical, and psychosocial needs. This role focuses on supporting individuals with serious mental illness (SMI), substance use disorders (SUD), co-occurring behavioral and physical health conditions, and complex social determinants of health. The Care Manager collaborates with members, caregivers, providers, and community resources to develop person-centered care plans that promote recovery, independence, safety, and improved health outcomes.

The Behavioral Health Care Manager serves as an advocate for members and ensures appropriate access to behavioral health, medical, long-term care, and community-based services while maintaining compliance with Medicaid, Medicare, and regulatory requirements.

Essential Duties and Responsibilities

• Conduct comprehensive psychosocial, behavioral health, and care management assessments.
• Develop, implement, monitor, and update individualized care plans based on member goals, needs, and preferences.
• Coordinate behavioral health, medical, pharmacy, and social support services across multiple providers and settings.
• Identify and address barriers to care, including housing instability, food insecurity, transportation needs, and lack of social support.
• Facilitate referrals and linkage to community resources, behavioral health services, HCBS programs, and supportive services.
• Monitor member progress through regular outreach, care plan reviews, and interdisciplinary case discussions.
• Coordinate transitions of care following hospitalizations, psychiatric admissions, skilled nursing facility stays, emergency department visits, and rehabilitation services.
• Provide crisis intervention support and facilitate appropriate behavioral health referrals as needed.
• Promote recovery-oriented, trauma-informed, and culturally competent care practices.
• Collaborate with psychiatrists, therapists, primary care providers, care management teams, and community partners.
• Educate members and caregivers regarding treatment plans, medication compliance, self-management, and available resources.
• Identify gaps in care and implement interventions to improve member outcomes and quality metrics.
• Participate in interdisciplinary team meetings, utilization reviews, and case conferences.
• Maintain timely and accurate documentation in compliance with organizational, state, federal, Medicaid, Medicare, and accreditation requirements.
• Ensure completion of required assessments, care plans, outreach activities, and regulatory documentation within established timeframes.
• Manage a caseload of members with varying levels of behavioral and medical complexity.

Required Qualifications

• Must be licensed in NY as LMSW or LCSW.
• Work schedule is Mon - Fri 08:30-05:00 PM EST
• Minimum of 3 years of experience in behavioral health, care management, case management, social work, managed care, health home, or related healthcare setting.
• Experience working with adults with serious mental illness, substance use disorders, and co-occurring behavioral and physical health conditions.
• Experience working with Medicaid and/or Medicare populations required.
• Experience coordinating services across behavioral health, medical, long-term care, and community-based settings

Education

• Master's Degree in Social Work (MSW) from an accredited institution required.

Licensing

• Current New York State Licensed Master Social Worker (LMSW) required.
• Clinical licensure (LCSW) strongly preferred.

Preferred Qualifications

• Experience in Managed Medicaid, Medicare Advantage, Dual Eligible populations, MLTC, Health Home, or Integrated Care programs.
• Knowledge of HCBS, supportive housing, community mental health resources, and long-term services and supports (LTSS).
• Case Management Certification (CCM, ACM, or equivalent).
• Bilingual skills preferred English/Spanish

Knowledge, Skills, and Abilities

• Strong understanding of behavioral health diagnoses, treatment modalities, and recovery principles.
• Knowledge of Medicaid, Medicare, Managed Care, and behavioral health regulations.
• Knowledge of serious mental illness, substance use disorders, crisis intervention, and trauma-informed care.
• Excellent assessment, care coordination, and care planning skills.
• Strong clinical judgment and critical-thinking abilities.
• Ability to effectively engage members with complex psychosocial and behavioral health needs.
• Excellent communication, motivational interviewing, and relationship-building skills.
• Ability to work independently and manage a high-volume caseload.
• Proficiency with electronic medical records and care management platforms.
• Strong organizational skills and attention to detail.

Core Competencies

• Member-Centered Care
• Clinical Assessment
• Behavioral Health Expertise
• Care Coordination
• Crisis Management
• Collaboration and Teamwork
• Regulatory Compliance
• Cultural Competency
• Communication and Engagement
• Problem Solving and Critical Thinking

Performance Expectations

• Timely completion of assessments, care plans, and required member contacts.
• Achievement of member engagement and quality metrics.
• Effective coordination of behavioral health and medical services.
• Compliance with all documentation and regulatory requirements.
• Successful management of high-risk members and transitions of care.
• Contribution to improved member outcomes, reduced avoidable hospitalizations, and enhanced quality of life.

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments .

We anticipate the application window for this opening will close on: 09/30/2026

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