Clinical Case Manager

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. Business Overview The mission of Aetna Better Health of Louisiana (ABH-LA) is to build a healthier world through better health, better care, and lower costs. We have embraced the quintuple aim as our guiding framework that integrates population health, equity, cost reduction, patient experience, and care team wellbeing into everything we do. We are leading the change by challenging the status quo with new technologies, VPB models, innovation, and integration of behavioral and physical health; and attracting and inspiring our local team by unlocking the power of our people to transform health care. Position Summary The Clinical Case Manager Behavioral Health (CM-BH) utilizes advanced clinical judgement 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 wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. The Clinical Case Manager BH is a full time telework position in Louisiana. In-state travel is required to conduct face to face visits and in-person outreach. This position is ABH- Louisiana Children's Specialty Foster Care program. Schedule is Monday - Friday, 8am-5pm, standard business hours. No nights, weekends, and no holidays. A flexible work schedule may be available after 6 months of service and with demonstrated performance and attendance. Fundamental Components Assessment of Members Using clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues. Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services. Enhancement of Medical Appropriateness and Quality of Care Application and/or interpretation of 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. Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view to achieve optimal outcomes. 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 motivational interviewing skills to ensure maximum member engagement and promotes 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. Analyzes all utilization, self-report, and clinical data available to consolidate information and begin to identify comprehensive member needs. Monitoring, Evaluation and Documentation of Care 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. Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment. Effective communication skills, both verbal and written. Required Qualifications Must reside in Louisiana Must have reliable transportation and the ability to travel in-state up to 50% of the time. Unencumbered Independent Behavioral Health Clinical license in the state of Louisiana (e.g., LCSW, LPC, LMFT) 3+ years of direct clinical practice experience post master's degree, with general youth or pediatrics population in a hospital setting, alternative care setting such as ambulatory care, residential, or outpatient clinic/facility 2+ years of experience with personal computers, keyboards and multi-system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint, etc.) Preferred Qualifications Certified Case Manager (ACM) preferred. Crisis Intervention skills Child Welfare and/or Juvenile Justice experience Managed care/utilization review experience Case management and discharge planning experience Education Masters' degree required /specialized training/relevant professional qualification. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,095.00 - $116,760.00 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: 09/11/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr