Care Plan Reviewer – Clinical Case Manager, Behavioral Health

This is a fully remote position, open to applicants in Kentucky, +3 more states.

📋 Description

• Perform thorough evaluations of referred members' needs and eligibility utilizing clinical tools and data analysis.

• Identify case-resolution strategies by assessing benefit plans and both internal and external programs/services.

• Utilize clinical judgment and tactics to mitigate risk factors and manage complex clinical indicators.

• Provide crisis intervention for members facing behavioral health or medical emergencies.

• Direct members to suitable clinical providers and ensure crisis follow-up is conducted.

• Apply and interpret clinical criteria, guidelines, case management plans, policies, procedures, and regulatory standards.

• Collaborate with supervisors, Medical Directors, and other programs to address care obstacles.

• Present cases during multidisciplinary case conferences.

• Recognize and escalate quality-of-care concerns.

• Advocate for appropriate care through effective communication with medical and behavioral health professionals.

• Employ motivational interviewing techniques to enhance member engagement and facilitate healthy behavior changes.

• Offer coaching, information, and support for independent medical decisions and healthy lifestyle choices.

• Assist members in making informed healthcare decisions.

• Analyze utilization, self-reported, and clinical data to determine comprehensive member needs.

• Develop and oversee care plans in collaboration with members and care teams.

• Implement case management and quality management processes in accordance with regulatory, accreditation, and company standards.

⛳️ Requirements

• Must be a resident of OH, KY, WV, or LA.

• Hold an active Behavioral Health license in Ohio (e.g., LMFT, LSW, LPC, LISW); colleagues from outside Ohio must secure the necessary licensure within 60 days of employment.

• Possess over 3 years of direct clinical practice experience following a Master's degree.

• Have a minimum of 2 years' experience in children's mental health, child welfare, developmental disabilities, juvenile justice, human services, or behavioral healthcare, delivering community-based services to children and youth and their families/caregivers.

• Have at least 2 years of experience related to family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development.

• Be willing and able to travel up to 10% for occasional regional training/meetings in Ohio, including quarterly meetings/training at the Columbus, Ohio office.

• Be available to work Monday–Friday, 8am–5pm.

• Have at least 1 year of experience with personal computers, keyboarding, navigating multiple systems, and utilizing MS Office Suite applications.

• Hold a minimum Master's degree in Counseling, Social Work, or Marriage and Family Therapy.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.