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

CVS Health•Elyria, OH

6d•$21 - $41•Hybrid

About The Position

CVS Health is hiring a full-time, field-based telework Care Management Coordinator for its OhioRISE program in Ohio. The role serves children with serious or complex behavioral health needs who are involved in, or at risk of involvement in, multiple child-serving systems. The coordinator supports comprehensive, highly coordinated behavioral health services through collaboration among members, families, MCOs, vendors, the Ohio Department of Medicaid, and other partners. The position requires residence in Ohio and travel within the assigned Northeast/Northwest Ohio region to member homes and other requested locations, up to 50% or more of the time. Some travel to the New Albany office may be required for trainings or meetings. The stated schedule is Monday through Friday, 8 a.m. to 5 p.m., with flexibility to work later as needed to meet member needs. The coordinator uses critical thinking and judgment to support the case management process and facilitate appropriate healthcare outcomes. This includes assessing member needs and eligibility, identifying risks and service needs, recommending resources and referrals, implementing and monitoring care plans, and coordinating with members’ Child and Family Teams. The role also supports quality and medical appropriateness, addresses barriers to care, promotes member engagement and informed healthcare decisions, and documents services in accordance with regulatory, accreditation, and company requirements.

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 with personal computers, keyboarding, multi-system navigation, and MS 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.
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 core Monday–Friday, 8 a.m.–5 p.m. business hours as needed.

Nice To Haves

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

Responsibilities

Manage complex cases in the community across child-serving systems using clinical and cultural competence and responsiveness.
Evaluate referred members’ needs and eligibility using care management tools and data, and recommend case resolution approaches or services.
Review benefit plans and available internal and external programs and services to identify appropriate supports.
Identify high-risk factors and service needs that may affect 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 or behavioral health programs to address barriers to goals and objectives.
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.
Use negotiation skills to secure appropriate options and services that meet member benefit or healthcare needs.
Use influencing and motivational interviewing skills to encourage member engagement and support lifestyle or behavior changes.
Provide coaching, information, and support to help members make independent medical and healthy-lifestyle choices.
Help members participate actively and knowledgeably in healthcare decisions with their providers.
Serve as a single point of contact for members and help 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.