Care Management Coordinator (North East Region) OhioRISE

CVS Health•Strongsville, OH

5d•Hybrid

About The Position

The Care Management Coordinator supports OhioRISE, a program focused on providing comprehensive, 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 role uses critical thinking and judgment to support case management and facilitate appropriate healthcare outcomes through care coordination, member support, and education, using care management tools and resources. This is a full-time, field-based telework position in Ohio. The coordinator must reside in Ohio and may reside in the Northeast region, with a strong preference for candidates in Cuyahoga, Lorain, Medina, Summit, Lake, or Geauga counties. The role requires travel within the assigned region to members’ homes and other requested locations, up to 50% or more of the time. The work 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 training or meetings. The coordinator evaluates members’ needs and eligibility, identifies risk factors and service needs, recommends approaches to address needs, and coordinates and monitors care plan activities. The role collaborates with case managers, supervisors, Medical Directors, multidisciplinary teams, members’ Child and Family Teams, and community resources to address barriers and support quality outcomes. It also supports member engagement and informed decision-making, helps resolve immediate care and access gaps, and documents care in accordance with 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, keyboarding, navigating 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 areas: 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-level clinician qualification required.
Must reside in Ohio.
Must be willing and able to travel within the assigned region up to 50% of the time.
Reliable transportation required.
Must be willing and able to work beyond Monday–Friday, 8 a.m.–5 p.m. core hours as needed.

Nice To Haves

Degree in behavioral health, human services, health services, or public health, such as psychology, social work, marriage and family therapy, counseling, or juvenile justice.
Case management and discharge planning experience.
Managed care experience.
Medicaid experience.

Responsibilities

Conduct comprehensive evaluations of referred members’ needs and eligibility using care management tools and available information.
Review members’ benefit plans and available internal and external programs and services to recommend approaches for resolving cases and meeting needs.
Identify high-risk factors and service needs that may affect member outcomes and care planning; 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 services and options that meet members’ benefits and healthcare needs.
Use influencing and motivational interviewing skills to encourage member engagement and promote lifestyle or behavioral changes.
Provide coaching, information, and support to empower members to make independent medical and healthy-lifestyle choices.
Help members participate knowledgeably with providers in healthcare decision-making.
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.
Travel within the assigned region to member homes and other requested member locations, and attend occasional trainings or meetings at the New Albany office.