, Illinois

Job Description
Provides case management services which may include pre-admission, concurrent, discharge and/or retro review, follow-up assessment or outreach phone.Monitor clinical care services provided to members related to mental health and substance abuse treatment to optimize clinical outcomes. Provide telephone triage, crisis intervention and emergency authorizations as assigned. 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/authorization questions and concerns regarding specific cases. Participate in QI activities including data collection, tracking, and analysis. A Behavioral Health Care Manager who is a licensed Psychologist may render denials when the coverage request is within the psychologist's scope of practice and his or her clinical experience. Inpatient care and prescription medication denials can only be rendered by a psychiatrist unless state regulations permit these denials to be rendered by a psychologist

Required Qualifications
3 years post degree experience in a psychiatric or substance abuse setting required
Unencumbered Behavioral Health clinical license in the state of Illinois (ex. RN, LCPC, LCSW, LMFT) required

Preferred Qualifications
Masters or Doctoral degree in behavioral health field preferred
MS Office experience preferred
3+ years experience in managed care preferred
Minimum of 2 years experience in the delivery of Behavior Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the state of Illinois preferred

Education
Bachelor's degree or equivalent experience

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. See Job Description

, Illinois

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

Careers for Veterans and Military Spouses

 

"The military has an ethos that is grounded in purpose-driven service that’s bigger than the individual. The same holds true for us at CVS Health. You can talk to colleagues in any part of our business and they will be able to articulate our company’s purpose. Working here provides an opportunity for service members and military spouses to continue to serve, just in a civvies."

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