Clinical Case Manager Behavioral Health - Work at Home - NY

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Summary The Behavioral Health Care Manager is responsible for coordinating, assessing, planning, and managing services for members with behavioral health, medical, and psychosocial needs. This role focuses on supporting individuals with serious mental illness (SMI), substance use disorders (SUD), co-occurring behavioral and physical health conditions, and complex social determinants of health. The Care Manager collaborates with members, caregivers, providers, and community resources to develop person-centered care plans that promote recovery, independence, safety, and improved health outcomes. The Behavioral Health Care Manager serves as an advocate for members and ensures appropriate access to behavioral health, medical, long-term care, and community-based services while maintaining compliance with Medicaid, Medicare, and regulatory requirements. Essential Duties and Responsibilities Conduct comprehensive psychosocial, behavioral health, and care management assessments. Develop, implement, monitor, and update individualized care plans based on member goals, needs, and preferences. Coordinate behavioral health, medical, pharmacy, and social support services across multiple providers and settings. Identify and address barriers to care, including housing instability, food insecurity, transportation needs, and lack of social support. Facilitate referrals and linkage to community resources, behavioral health services, HCBS programs, and supportive services. Monitor member progress through regular outreach, care plan reviews, and interdisciplinary case discussions. Coordinate transitions of care following hospitalizations, psychiatric admissions, skilled nursing facility stays, emergency department visits, and rehabilitation services. Provide crisis intervention support and facilitate appropriate behavioral health referrals as needed. Promote recovery-oriented, trauma-informed, and culturally competent care practices. Collaborate with psychiatrists, therapists, primary care providers, care management teams, and community partners. Educate members and caregivers regarding treatment plans, medication compliance, self-management, and available resources. Identify gaps in care and implement interventions to improve member outcomes and quality metrics. Participate in interdisciplinary team meetings, utilization reviews, and case conferences. Maintain timely and accurate documentation in compliance with organizational, state, federal, Medicaid, Medicare, and accreditation requirements. Ensure completion of required assessments, care plans, outreach activities, and regulatory documentation within established timeframes. Manage a caseload of members with varying levels of behavioral and medical complexity.

Must be licensed in NY as LMSW or LCSW. Work schedule is Mon - Fri 08:30-05:00 PM EST Minimum of 3 years of experience in behavioral health, care management, case management, social work, managed care, health home, or related healthcare setting. Experience working with adults with serious mental illness, substance use disorders, and co-occurring behavioral and physical health conditions. Experience working with Medicaid and/or Medicare populations required. Experience coordinating services across behavioral health, medical, long-term care, and community-based settings Education Master's Degree in Social Work (MSW) from an accredited institution required. Licensing Current New York State Licensed Master Social Worker (LMSW) required. Clinical licensure (LCSW)