The Clinical Case Manager BH is a full time telework position that requires some travel. This position is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies.
Fundamental Components:
Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
At Mercy Care, our vision is for our members to live their healthiest lives and achieve their full potential. We’re a local company, serving Arizonans of all ages who are eligible for Medicaid since 1985. We also serve people who are eligible for both Medicaid and Medicare. Mercy Care is sponsored by Dignity Health and Ascension Health and is administered by Aetna, a CVS Health Business. In April 2021 we’re going to begin delivering integrated physical and behavioral health services to children involved with the child welfare system, in a unique partnership with the Arizona Department of Child Safety and their Comprehensive Health Plan. We value diversity, compassion, innovation, collaboration and advocacy. If your values are the same as ours, let’s work together to make a difference and improve the health and wellbeing of Arizona.
Required Qualifications
3+ years of pre-clinical and/or clinical experience with focus on pediatrics
3+ years of behavioral health experience
This position requires the ability to travel in state with a personal vehicle up to 10% of the time. Qualified candidates must have a valid AZ driver’s license, reliable transportation, and proof of vehicle insurance.
Flexibility to work beyond the core business hours of Monday-Friday, 8am-5pm, is required. We are serving the needs of children and families that may require meeting after school, after work, etc.
Preferred Qualifications
Case management and discharge experience
Managed care experience
Education
Masters required
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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