Clinical Case Manager, Behavioral Health

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Conduct thorough evaluations of the needs and eligibility of referred members.

• Create strategies for case resolution utilizing benefit plans alongside internal and external programs and services.

• Employ clinical judgment to mitigate risk factors and address intricate clinical indicators.

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

• Direct members to suitable clinical providers and ensure follow-up after crises.

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

• Collaborate with supervisors, Medical Directors, and other programs to navigate barriers.

• Present cases during conferences to gather multidisciplinary insights.

• Spot and escalate quality-of-care concerns.

• Liaise with medical and behavioral health professionals to guide appropriate care.

• Utilize motivational interviewing techniques to engage members and encourage lifestyle or behavioral changes.

• Offer coaching, information, and support for autonomous health choices.

• Assist members in making informed decisions about their healthcare.

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

• Formulate and oversee care plans with members and care teams.

• Employ case management and quality management processes to comply with regulatory, accreditation, and company standards.

• Conduct in-person visits and outreach requiring necessary in-state travel.

⛳️ Requirements

• Must be a resident of Louisiana.

• Reliable transportation is essential.

• Willingness to travel in-state up to 50% of the time.

• Unencumbered Independent Behavioral Health Clinical license in Louisiana (e.g., LCSW, LPC, LMFT).

• A minimum of 3 years of direct clinical practice experience post-master’s degree with a general youth or pediatric population in a hospital, ambulatory care, residential, or outpatient clinic/facility setting.

• At least 2 years of experience with personal computers, keyboards, multi-system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint, etc.).

• A Master’s degree is required, along with specialized training or relevant professional qualifications.

• Certification as a Case Manager (ACM) is preferred.

• Crisis Intervention skills are preferred.

• Experience in Child Welfare and/or Juvenile Justice is preferred.

• Background in managed care/utilization review is preferred.

• Experience in case management and discharge planning is preferred.

• Strong verbal and written communication skills are necessary.

• Ability to juggle multiple tasks, prioritize effectively, and adjust in a fast-paced environment.

🏝️ Benefits

• Flexible work schedule may be available after 6 months of service with demonstrated performance and attendance.

• 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 bonuses, commissions, or short-term incentive programs in addition to base pay.