Care Management Coordinator OhioRISE - Field - Central/SE Ohio

CVS Health•Lancaster, OH

6d•$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 becoming involved in—multiple child-serving systems. The coordinator uses critical thinking and judgment to facilitate appropriate healthcare outcomes by providing care coordination, support, and education to members and their families. This is a full-time, field-based telework position for someone residing in Ohio, serving the Central and Southeast Ohio region. The role requires travel to member homes and other requested locations within the assigned region, 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. Travel to the New Albany office may be required for trainings or meetings. The coordinator evaluates member needs and eligibility, identifies risks and service needs, recommends approaches to resolve care needs, and coordinates and monitors care plan activities. The role works with members’ Child and Family Teams, case managers, supervisors, Medical Directors, providers, and community resources to overcome barriers and promote appropriate, high-quality care. The coordinator also supports member engagement and informed healthcare decisions, addresses immediate gaps in care and access, and documents work in accordance with regulatory, accreditation, and company requirements.

Requirements

Bachelor’s degree or non-licensed master-level clinician credential.
At least 2 years of experience in behavioral health, social services, or human services.
At least 2 years of experience using personal computers, keyboarding, multi-system navigation, 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 healthcare, 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; 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.
Mileage is reimbursed according to the company expense reimbursement policy.

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, such as psychology, social work, marriage and family therapy, counseling, or juvenile justice.

Responsibilities

Use care management tools and available information to assess referred members’ needs and eligibility, recommend approaches to address those needs, and evaluate applicable benefits and internal or external services.
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.
Coordinate 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 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.
Negotiate for appropriate options and services to meet members’ benefits and healthcare needs.
Use influencing and motivational interviewing skills to encourage member engagement and support behavior or lifestyle changes.
Coach and support members so they 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.
Use case management and quality management processes and document work in compliance with regulatory and accreditation guidelines and company policies and procedures.
Travel within the assigned Central and Southeast Ohio region to member homes and other requested locations, and attend trainings or meetings at the New Albany office when required.