Case Manager Behavioral Health (LCSW, LCPC) Field - Cook County

Position Summary Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best‑in‑class operating and clinical models. We can have a life‑changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Fundamental Components & Physical Requirements Assessment of Members Through the use of clinical tools and information/data review, conduct comprehensive assessments of referred member's needs/eligibility. Determine approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. Apply clinical judgment to incorporate strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues. Perform crisis intervention with members experiencing a behavioral health or medical crisis and refer them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated. Provide crisis follow‑up to members to help ensure they are receiving the appropriate treatment/services. Enhancement of Medical Appropriateness and Quality of Care Apply or interpret 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. Consult with supervisors, Medical Directors, and/or other programs to overcome barriers to meeting goals and objectives; present cases at case conferences to obtain multidisciplinary views in order to achieve optimal outcomes. Identify and escalates quality of care issues through established channels. Speak to medical and behavioral health professionals to influence appropriate member care. Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. Provide coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Help member actively and knowledgably participate with their provider in healthcare decision‑making. Analyze all utilization, self‑report and clinical data available to consolidate information and identify comprehensive member needs. Monitoring, Evaluation and Documentation of Care Collaborate with the member and their care team to develop and monitor established plans of care to meet the member's goals. Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures. Remote Work Expectations This is a remote‑hybrid role; candidates must have a dedicated workspace free of interruptions. Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. Required Qualifications Must reside in Illinois. 3–5 years clinical practical experience. 2–3 years CM, discharge planning and/or home health care coordination experience. Confidence working at home/independent thinker using tools to collaborate and connect with teams virtually. Must possess reliable transportation and be willing and able to travel up to 50% in Cook County and surrounding areas. Mileage is reimbursed per our company expense reimbursement policy. Excellent analytical and problem‑solving skills. Effective communication, organizational, and interpersonal skills. Ability to work independently. Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications. Efficient and effective computer skills, including navigating multiple systems and keyboarding. Preferred Qualifications Certified Case Manager. Bilingual. Education Master's Degree in Behavioral/Mental Health or related field. License LCSW or LCPC in the state of Illinois. Anticipated Weekly Hours 40 Time Type Full time Pay Range $66,575.00 - $142,576.00 The typical pay range for this role is: $66,575.00 - $142,576.00. This 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 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. Benefits 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. Benefits 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. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr Hispanic Alliance for Career Enhancement