Care Management Coordinator OhioRISE - Field - Central/SE Ohio

CVS Health•Lancaster, OH

5d•$21 - $41•Hybrid

About The Position

The Care Management Coordinator supports the 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 collaborates with members, families, Child and Family Teams, providers, case managers, and other partners to facilitate appropriate healthcare outcomes through care coordination, support, and education. This is a full-time, field-based and telework position in Ohio. The coordinator must reside in Ohio and in central or southeastern Ohio, and travel within the assigned region to member homes and other requested locations up to 50% or more of the time. The regular schedule is Monday through Friday, 8 a.m. to 5 p.m., with flexibility to work later as needed to meet member needs. Some travel to the New Albany office may be required for trainings or meetings. The role uses care management tools and information review to evaluate member needs and eligibility, identify risks and service needs, recommend approaches to resolving care needs, coordinate and monitor care plans, and make referrals when appropriate. The coordinator works to address barriers, support member engagement and informed healthcare decisions, connect members to appropriate services, and document care in accordance with applicable regulatory, accreditation, and company requirements.

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 care 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.
Bachelor's degree or non-licensed master's-level clinician required.
Must reside in Ohio and in central or southeastern Ohio.
Must be willing and able to travel within the assigned region up to 50% of the time; reliable transportation is required.
Must be willing and able to work beyond Monday–Friday, 8 a.m.–5 p.m. core business hours as needed.

Nice To Haves

Case management and discharge planning experience.
Managed care experience.
Medicaid experience.
A degree in behavioral health, human services, health services, or public health; examples include psychology, social work, marriage and family therapy, counseling, or juvenile justice.

Responsibilities

Evaluate referred members' needs and eligibility using care management tools and available information, and recommend approaches to address needs.
Review benefit plans and internal and external programs or services to identify appropriate resources.
Identify high-risk factors and service needs that may affect outcomes or 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 or behavioral health programs to address barriers and achieve care goals.
Present cases at case conferences for multidisciplinary review.
Work collaboratively with members' Child and Family Teams.
Identify and escalate quality-of-care issues through established channels.
Negotiate to secure appropriate service options needed to meet members' benefits or healthcare needs.
Use influencing and motivational interviewing skills to engage members and encourage lifestyle or behavior changes.
Provide coaching, information, and support that help members make independent medical and healthy-lifestyle choices and participate knowledgeably in healthcare decisions.
Serve as a single point of contact for members and help address immediate or 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.