Care Management Coordinator - Field - OhioRISE Central/SE Ohio

About the role

This is a full-time field-based and telework position, in Ohio. This position requires the ability to travel within the assigned region of Ohio to member homes and other requested member locations, up to 50% or more of the time. Applicants must reside in central or southeastern Ohio. Preferred counties: Ashland, Athens, Coshocton, Delaware, Fairfield, Fayette, Gallia, Guernsey, Highland, Hocking, Holmes, Jackson, Knox, Licking, Meigs, Morgan, Morrow, Muskingum, Noble, Perry, Pickaway, Pike, Richland, Ross, Vinton, Washington and Wayne.

Responsibilities

• Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
• Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
• Carefully coordinates and implements assigned care plan activities and monitors care plan progress.
• Enhances medical appropriateness and quality of care: Using a holistic approach, consults with case managers, supervisors, Medical Directors and/or other health/behavioral health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Collaborates with the members' Child and Family Teams.
• Identifies and escalates quality of care issues through established channels.
• Uses negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgeably participate with their provider in healthcare decision-making.
• Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access.
• Maintains monitoring, evaluation, and documentation of care using case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

• 2+ years of experience in behavioral health, social services, or human services.
• 2+ years of experience with personal computers, keyboard and multi-system navigation, and MS Office Suite applications (Outlook, Word, Excel, SharePoint).
• 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 family/caregivers.
• 2+ years of experience with one or more of the following areas of expertise: family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development.
• 2+ years of experience with Ohio delivery systems, including local community networks and resources.
• 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/meetings.
• Reliable transportation required.
• Mileage is reimbursed per our company expense reimbursement policy.
• Willing and able to work beyond core business hours of Monday-Friday, 8am-5pm, as needed.
• Bachelor’s degree or non-licensed master level clinician required.
• Must reside in Ohio.

Preferred Qualifications

• Case management and discharge planning experience.
• Managed Care experience.
• Medicaid experience.

Qualifications

• Education: Bachelor’s degree or non-licensed master level clinician required, with either degree being in behavioral health, human services, health services, or public health preferred. (i.e. psychology, social work, marriage and family therapy, counseling, juvenile justice).

Pay Range

The Typical Pay Range For This Role Is $21.10 - $40.90. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.