Care Management Coordinator OhioRISE - Field - Northeast/Northwest Region Ohio

CVS Health•Scott Township, OH

21h•$21 - $41•Hybrid

About The Position

The Care Management Coordinator supports CVS Health’s OhioRISE program, which provides comprehensive, coordinated behavioral health services for children with serious or complex behavioral health needs who are involved in, or at risk of involvement in, multiple child-serving systems. The coordinator uses critical thinking and judgment to support the case management process and facilitate appropriate health outcomes by coordinating care, providing support and education, and using care management tools and resources. The position is full-time and field-based in Ohio, with travel to member homes and other requested locations within the assigned Northeast/Northwest Ohio region up to 50% or more of the time. The coordinator must reside in Ohio; residence in specified regional counties is strongly preferred. Work is generally Monday through Friday, 8 a.m. to 5 p.m., with flexibility to work later to meet member needs. The role involves evaluating referred members’ needs and eligibility, identifying risks and service needs, coordinating care plan activities, and monitoring progress. The coordinator works with members, families, Child and Family Teams, case managers, supervisors, Medical Directors, and other programs to address barriers and support appropriate, high-quality care. The coordinator also promotes member engagement and informed decision-making, helps address gaps in care and access, escalates quality-of-care concerns, and follows applicable regulatory, accreditation, and company processes for case management and quality management.

Requirements

At least 2 years of experience in behavioral health, social services, or human services.
At least 2 years of experience using personal computers, keyboards, multiple systems, and Microsoft Office applications, including Outlook, Word, Excel, and SharePoint.
At least 2 years of experience in children’s mental health, child welfare, developmental disabilities, juvenile justice, or a public-sector human services or behavioral health field, providing community-based services to children and youth and their families or caregivers.
At least 2 years of experience in one or more of the following: family systems, community systems and resources, case management, child and family counseling or therapy, child protection, or child development.
At least 2 years of experience with Ohio delivery systems, including local community networks and resources.
Ability and willingness to travel within the assigned region up to 50% of the time; some travel to the New Albany office may be required for trainings or meetings.
Reliable transportation.
Ability and willingness to work beyond Monday–Friday, 8 a.m.–5 p.m. core business hours as needed.
Must reside in Ohio.
Bachelor’s degree or non-licensed master-level clinician degree required.

Nice To Haves

Case management and discharge planning experience.
Managed care experience.
Medicaid experience.
Degree in behavioral health, human services, health services, or public health, such as psychology, social work, marriage and family therapy, counseling, or juvenile justice.
Residence in Cuyahoga, Summit, Medina, Portage, Marion, Wyandot, Crawford, Sandusky, Stark, Belmont, Jefferson, Huron, Harrison, Lake, Geauga, Lorain, or Ashtabula County.

Responsibilities

Use care management tools and available information to evaluate referred members’ needs and eligibility, recommend approaches to address needs, and assess benefit plans and available internal and external services.
Identify high-risk factors and service needs that may affect member outcomes and care planning, and refer members to clinical case management or crisis intervention when appropriate.
Coordinate and implement assigned care plan activities and monitor progress.
Consult with case managers, supervisors, Medical Directors, and other health and behavioral health programs to address barriers and meet care goals.
Present cases at case conferences for multidisciplinary review and collaborate with members’ Child and Family Teams.
Identify and escalate quality-of-care issues through established channels.
Negotiate to secure appropriate services and options that meet members’ benefits and healthcare needs.
Use influencing and motivational interviewing skills to engage members and encourage health or lifestyle changes.
Provide coaching, information, and support so members can make independent medical and healthy lifestyle choices and participate knowledgeably in healthcare decisions with providers.
Serve as a single point of contact and help members address immediate and acute gaps in care and access.
Use case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.