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CVS Health Licensed Clinical Social Worker - Bilingual Spanish - San Antonio, TX in San Antonio, Texas

Job Description

This position will be working from home and will require the employee to travel up to 50% of the timeThe dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services across the Enterprise. Social Workers play an integral role on the Interdisciplinary Team to work with Members to reach their health care goals. CVS-Aetna has a competitive edge in the health care industry and strive to continue to evolve as consumer obsessed teams collectively work on driving members goals of a healthier quality of life.Utilizes advanced clinical judgment and critical thinking skills to facilitate timely and appropriate assessment of the member as it relates to, behavioral health care and other needs as indicated by assessment and care planning. Coordinates direct provider coordination/collaboration and assesses psychosocial needs to promote effective utilization of available resources and optimal, cost-effective outcomes. The Field Care Manager uses a collaborative process of working on an Interdisciplinary Team across all lines of business, including, Medicare, and Commercial plans. The Field Care Manager works with the Members by assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needsAssessment of Members: Through the use of clinical tools and information/data review, in members record and other sources, conducts comprehensive assessments of referred member’s needs/eligibility & 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. -Performs job related functions by providing Field Work to Members by doing face to face visits, and in-home assessment on members overall functional status related to Social Determinants of Health that may hinder them from meeting their health care goals. Utilizes all established work platforms required while conducting face to face visits with the Member These platforms are, but not limited to Salesforce, Med-Compass, ATV, and others as assigned. All documentation on members care plans completed in the assigned systems as listed. Performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment & treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services. Quality of Care and Services: Ensures quality of services that are in direct alignment with Medicare criteria and follows NCQM guidelines on all applicable criteria and clinical guidelines that include standardized case management plans, policies, procedures, & 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 & quality management processes in compliance with regulatory and accreditation guidelines & company policies & procedures.

Required Qualifications

3+ years of direct clinical practice experience post master’s degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facilityBilingual Spanish RequiredLCSW licensure requiredMust exercise independent and sound judgment in decision making. Must be highly organized to manage continuously changing priorities. Proficiency with computers – (MS Outlook, Excel, PowerPoint, and Word) and must navigate multiple systems simultaneously50% travel required

Preferred Qualifications

Case management and discharge planning experience preferred Managed care/utilization review experience preferred Crisis intervention skills preferredKnowledge of laws and regulations governing delivery of Medicare services.CCM Certification is a plus.



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.