Care Plan Reviewer – Clinical Case Manager, Behavioral Health

CVS Health Careers

. Conduct comprehensive assessments of referred members' needs and eligibility using clinical tools and data review .

Posted 11/10/2026full-timeRemote • United StatesMid-LevelSenior💰 $54,095 - $129,615 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in behavioral health case management, applying clinical judgment and strategies to address complex needs while ensuring compliance with regulatory standards. Proficient in utilizing motivational interviewing techniques to enhance member engagement and support healthy lifestyle choices.

Highest-signal resume keywords

Active Behavioral Health License3+ Years Direct Clinical Practice ExperienceExperience in Children's Mental HealthCase Management and Quality Management ProcessesMotivational Interviewing

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCrisis InterventionData AnalysisPlan DevelopmentBehavioral Health CareChild and Family CounselingCommunity-Based ServicesRegulatory ComplianceClinical Criteria InterpretationQuality-of-Care Issue Identification

Soft Skills

CommunicationCoachingInfluencingCollaborationProblem-Solving

Tools & Technologies

MS Office SuiteMulti-Systems NavigationClinical ToolsData Review Systems

Certifications & Qualifications

Master's Degree in CounselingMaster's Degree in Social WorkMaster's Degree in Marriage and Family Therapy

Industry Keywords

Behavioral HealthChild WelfareDevelopmental DisabilitiesJuvenile JusticeHuman ServicesFamily SystemsCommunity ResourcesChild ProtectionChild DevelopmentHealthcare Decision-Making

About the role

Key responsibilities & impact

Conduct comprehensive assessments of referred members' needs and eligibility using clinical tools and data review
Determine case-resolution approaches by evaluating benefit plans and internal and external programs/services
Apply clinical judgment and strategies to reduce risk factors and address complex clinical indicators
Perform crisis intervention for members experiencing behavioral health or medical crises
Refer members to appropriate clinical providers and provide crisis follow-up
Apply and interpret clinical criteria, guidelines, case management plans, policies, procedures, and regulatory standards
Consult with supervisors, Medical Directors, and other programs to overcome care barriers
Present cases at multidisciplinary case conferences
Identify and escalate quality-of-care issues
Influence appropriate care through communication with medical and behavioral health professionals
Use motivational interviewing to promote member engagement and healthy behavior changes
Provide coaching, information, and support for independent medical and healthy lifestyle choices
Help members participate knowledgeably in healthcare decision-making
Analyze utilization, self-report, and clinical data to identify comprehensive member needs
Develop and monitor plans of care with members and care teams
Use case management and quality management processes in compliance with regulatory, accreditation, and company requirements

Requirements

What you’ll need

Must reside in OH, KY, WV, or LA
Active Behavioral Health license in the state of Ohio (e.g., LMFT, LSW, LPC, LISW); colleagues outside Ohio must obtain the required licensure within 60 days of hire
3+ years of direct clinical practice experience post-Master's degree
2+ years of experience in children's mental health, child welfare, developmental disabilities, juvenile justice, human services, or behavioral health care, providing community-based services to children and youth and their families/caregivers
2+ years of experience in family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development
Willing and able to travel up to 10% for occasional regional trainings/meetings in Ohio, including quarterly meetings/trainings at the Columbus, Ohio office
Willing to work Monday–Friday, 8am–5pm
1+ year of experience with personal computers, keyboard, multi-systems navigation, and MS Office Suite applications
Minimum Master's degree in Counseling, Social Work, or Marriage and Family Therapy

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program eligibility