Job Description This position will be a full-time telework anywhere in the United States.
Schedule is Monday-Friday, standard business hours.
No nights, no weekends and no holidays.
Utilizes advanced clinical judgment 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.
- Monitor clinical care services provided to members related to mental health and substance abuse treatment to optimize clinical outcomes. - Provide telephone triage and crisis intervention. - Provide information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Aetna Behavioral Health policies and procedures, and criteria. - Interact with Physician Advisors to discuss clinical questions and concerns regarding specific cases. - Participate in QI activities including data collection, tracking, and analysis. Telephonic clinical case management with Medicare population. - Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs. - Completes a Comprehensive Assessment and Plan of care. - Will document in clinical systems to support legacy Aetna and Coventry membership. - Provides BH consultation and collaboration with Aetna partners. - Active participation in clinical treatment rounds. - Active participation in team activities focused on program development. Innovative thinking expected.
Required Qualifications - 3+ years of direct clinical practice experience post degree e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility. - RN (current and unrestricted license) with behavioral health or DSNP experience required OR a qualifying BH degree (i.e. LPC, LPCC, LISW, LSW, LCSW) - Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Work requires sitting for extended periods, talking on the telephone and typing into the computer.
COVID Requirements COVID-19 Vaccination Requirement CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
Preferred Qualifications - 2+ years of managed care experience highly preferred - 2+ years of case management experience - 2+ years of behavioral health experience - Discharge planning experience - Utilization review, prior authorization, concurrent review, appeals experience - Advanced crisis intervention skills - CCM preferred - Bilingual preferred
Education - RN licensure (current and unrestricted license) OR a minimum of a Master's degree with a qualifying BH licensure (i.e. LPC, LPCC, LISW, LSW, LCSW)
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.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.
At CVS Health, we work every day to help people on their path to better health. Never has it been more important for us to deliver on our purpose to our valued customers, patients, members, and employees. With a presence in communities across the country, CVS Health colleagues are and will continue to be a critical piece of the country’s health care solution. The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together. If you would like to learn about the actions we are taking as a company as we learn more about COVID-19 and its spread, we encourage you to visit our COVID-19 resource center at https://cvshealth.com/covid-19
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to... attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. 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. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. Please note that we only accept applications for employment via this site.
We provide reasonable accommodations to qualified individuals with disabilities. If you need to request an accommodation, a qualified interpreter, written information in other formats, translation or other services, please contact our Advice and Counsel Reasonable Accommodations team by emailing Advice and Counsel Reasonable Accommodations team or calling 877-805-9511.
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