Care Management Coordinator OhioRISE - Field - Central/SE Ohio

CVS Health • Lancaster, OH

6d • $21 - $41 • Hybrid

About The Position

This is a full-time, field-based telework position serving OhioRISE members in Central and Southeast Ohio. The coordinator must reside in Ohio and travel within the assigned region to members’ homes and other requested locations, up to 50% or more of the time. Applicants may reside within the Central/SE care coordination region; residence in certain listed counties is strongly preferred. Some travel to the New Albany office may be required for trainings or meetings. The schedule is Monday through Friday, 8 a.m. to 5 p.m., with flexibility to work later as needed to meet member needs.

OhioRISE is an Ohio Medicaid program designed to provide comprehensive, highly coordinated behavioral health services to children with serious or complex behavioral health needs who are involved in, or at risk of involvement in, multiple child-serving systems. The Case Management Coordinator uses critical thinking and judgment to collaborate in the case management process and facilitate appropriate healthcare outcomes. The coordinator provides care coordination, support, and education using care management tools and resources.

The role requires clinical and cultural competence and experience managing complex community cases across child-serving systems. The coordinator evaluates referred members’ needs and eligibility, identifies risks and service needs, recommends approaches to address needs, coordinates and monitors care plan activities, and connects members with appropriate internal and external services. The coordinator works with case managers, supervisors, Medical Directors, other programs, and members’ Child and Family Teams; presents cases for multidisciplinary review; addresses barriers and quality-of-care concerns; and supports members in accessing services and participating in healthcare decisions. Case management and quality management processes must be followed in accordance with regulatory and accreditation guidelines and company policies.

Requirements

• Bachelor’s degree or non-licensed master-level clinician required.
• 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 public-sector human services or behavioral health care, 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.
• Must reside in Ohio.
• Must be 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 or meetings.
• Reliable transportation 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 is preferred, such as psychology, social work, marriage and family therapy, counseling, or juvenile justice.
• Residence in one of the preferred Central/Southeast Ohio counties: Athens, Ashland, Coshocton, Delaware, Fairfield, Fayette, Franklin, Gallia, Guernsey, Highland, Hocking, Holmes, Knox, Jackson, Licking, Meigs, Morgan, Morrow, Muskingum, Noble, Perry, Pickaway, Pike, Ross, Richland, Vinton, Washington, or Wayne.

Responsibilities

• Evaluate referred members’ needs and eligibility using care management tools and information or data review.
• Recommend approaches to resolve cases and meet member needs, taking benefit plans and available programs and services into account.
• Identify high-risk factors and service needs that may affect member outcomes and care planning, and make appropriate referrals to clinical case management or crisis intervention when indicated.
• Coordinate assigned care plan activities and monitor progress.
• Consult and collaborate with case managers, supervisors, Medical Directors, and other health or behavioral health programs to address barriers to care goals.
• Present cases at case conferences for multidisciplinary review and work collaboratively with members’ Child and Family Teams.
• Identify and escalate quality-of-care issues through established channels.
• Use negotiation skills to secure appropriate services and options that meet members’ benefit and healthcare needs.
• Use influencing and motivational interviewing skills to encourage member engagement and healthy behavior 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 for members and help address immediate or acute gaps in care and access.
• Apply case management and quality management processes in accordance with regulatory and accreditation guidelines and company policies and procedures.
• Travel within the assigned region to member homes and other requested locations, and work beyond core business hours when needed.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility
• Eligible for a CVS Health bonus, commission, or short-term incentive program in addition to base pay
• Mileage reimbursement under the company expense reimbursement policy

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level