Clinical Case Manager Behavioral Health

CVS Health

Toronto, Canada

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$60,522.00 - $129,615.00 Posted: August 30th, 2025

Job Description

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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Fully remote position with requirement to reside within the following Michigan counties : Clinton, Eaton, Ingham, Livingston, Jackson, Washtenaw, Hillsdale, Lenawee, Monroe, Oakland, Macomb, Wayne

Standard business hours : Monday - Friday 8 : 00 am - 5 : 00 pm EST.

Potential for travel for face to face visits up to 20% of your week.

This role is a telephonic clinical case management position working with our Medicaid population. Use of Motivational Interviewing skills, members are outreached and engaged in interventions that optimize member participation in case management programs.

BH CM 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.

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 knowledgably 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.

Required Qualifications

3+ years of direct clinical experience, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic / facility.

Must be a Michigan Resident residing within any of the following counties : Clinton, Eaton, Ingham, Livingston, Jackson, Washtenaw, Hillsdale, Lenawee, Monroe, Oakland, Macomb, or Wayne County

One of the following unrestricted licenses in the state of Michigan is required : LMSW or LPC

2+ years of foster care experience required

1+ year of case / care management required

Education

Minimum of a Master's Degree in a Behavioral / Mental Health / Social Work or Human Service Field

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

60,522.00 - $129,615.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great Benefits For Great People

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https : / / jobs.cvshealth.com / us / en / benefits

We anticipate the application window for this opening will close on : 09 / 09 / 2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Seniority level

Mid-Senior level

Employment type

Full-time

Job function

Health Care Provider

Industries

Hospitals and Health Care

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