Care Management Coordinator - Field - OhioRISE NE Ohio

CVS Health • Mentor, KY

22d • $21 - $37 • Remote

About The Position

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 This is a full-time field-based telework position, in Ohio. This position requires the ability to travel within the assigned region of Ohio to member homes and other requested member locations, up to 50% or more of the time. Applicants may reside within the Northeast region of Ohio. Strongly prefers candidates to reside in Cuyahoga county. Monday-Friday 8-5pm with flexibility needed to work later to meet member needs. Business Overview As part of the bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, OhioRISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems. The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. Must reside in Ohio. Fundamental Components: • Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems. • Evaluation of Members: o Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. o Coordinates and implements assigned care plan activities and monitors care plan progress. • Enhancement of Medical Appropriateness and Quality of Care: o Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health/behavioral health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes. o Works collaboratively with the members' Child and Family Teams. o Identifies and escalates quality of care issues through established channels. o Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs. o Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. o Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. o Helps member actively and knowledably participate with their provider in healthcare decision-making. o Serves a single point of contact for members and assist members to remediate immediate and acute gaps in care and access. • Monitoring, Evaluation and Documentation of Care: o Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

• 2+ years of experience in behavioral health, social services, or human services
• 2+ years of experience with personal computers, keyboard and multi-system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint).
• 2+ years of experience in children's mental health, child welfare, developmental disabilities, juvenile justice, or a public sector human services or behavioral health care field, providing community-based services to children and youth, and their family/caregivers.
• 2+ years experience in one or more of the following areas of expertise: family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development.
• 2+ year of experience with Ohio delivery systems, including local community networks and resources.
• Willing and able to travel within the assigned region up to 50% of the time; Some travel to the New Albany office may be required for trainings/meetings:
• Reliable transportation required
• Mileage is reimbursed per our company expense reimbursement policy
• Willing and able to work beyond core business hours of Monday-Friday, 8am-5pm, as needed.
• Bachelor’s degree or non-licensed master level clinician required
• Must reside in Ohio

Nice To Haves

• Case management and discharge planning experience.
• Managed Care experience.
• Medicaid experience.

Responsibilities

• Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems.
• Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
• Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health/behavioral health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Works collaboratively with the members' Child and Family Teams.
• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
• Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote 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 knowledably participate with their provider in healthcare decision-making.
• Serves a single point of contact for members and assist members to remediate immediate and acute gaps in care and access.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 5,001-10,000 employees