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Licensed Master Social Worker
CVS Health
- New York, New York, United States
- New York, New York, United States
Über
Location Remote – Must reside in one of these counties: Berrien, Van Buren, Cass, Kalamazoo, St. Joseph, Calhoun, Branch, Jackson, Hillsdale, Livingston, Washtenaw, Lenawee, Monroe, Oakland, Macomb, Wayne, Clinton, Eaton, or Ingham.
Employment Type 4+ Month Contract (Potential for extension)
Pay Rate $44.12/hr on W2
Shift M-F 8 AM-5 PM
Job Requirements
Add city, state and county at the top of their resume.
Primarily telephonic. No field work needed for this role.
Fully remote. Candidates will need a quiet, dedicated work space with no distractions. This role will require that the candidate be hard wired into the modem. Candidates will need to secure a long enough ethernet cord at their own expense.
Must have an LPC or LMSW – unrestricted and active in the state of Michigan.
Description The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost‑effective outcomes. Requires an LMSW or LCP with unrestricted active license.
Through the use of 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. Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits. Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Experience 3+ years of direct clinical experience, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.
Healthcare and/or managed care industry experience.
Case Management experience preferred – Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
Effective communication skills, both verbal and written.
Ability to multitask, prioritize and effectively adapt to a fast‑paced changing environment.
Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
Work requires the ability to perform close inspection of handwritten and computer‑generated documents as well as a PC monitor.
Typical office working environment with productivity and quality expectations.
One of the following unrestricted licenses in the state of Michigan is required: LMSW or LPC.
Education Minimum of a Master’s Degree in a Behavioral/Mental Health/Social Work or Human Service Field.
Case Management Certification CCM preferred.
Assessment of Members
Through the use of 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 in order 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 influencing/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 knowingly 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.
Majority of time is spent on telephonic outreach and documentation in a clinical case management platform.
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Sprachkenntnisse
- English
Hinweis für Nutzer
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