Care Management Coordinator OhioRISE - Field - Central and SE Region of Ohio

About the role

This is a full-time field-based telework position in Ohio. The role requires 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, with preferred counties including Franklin, 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. Core hours are Monday–Friday, 8 am–5 pm, with flexibility needed to work later to meet member needs.

Business Overview

As part of the Next Generation of managed care in Ohio Medicaid, OhioRISE will help struggling children and their families by coordinating care among MCOs, vendors, and ODM to address critical needs. The OhioRISE Program delivers comprehensive, highly coordinated behavioral health services for children with serious or complex behavioral health needs who are involved in, or at risk for involvement in, multiple child-serving systems.

Responsibilities

• Conduct comprehensive evaluation of referred members’ needs and eligibility using care management tools and data review; recommend approaches to case resolution and meeting needs by evaluating benefit plans and available internal and external programs/services.
• Identify high-risk factors and service needs that may impact member outcomes; make appropriate referrals to clinical case management or crisis intervention.
• Coordinate and implement assigned care plan activities; monitor progress toward goals.
• Consult with case managers, supervisors, Medical Directors, and other health/behavioral health programs to overcome barriers; present cases at conferences for multidisciplinary review to achieve optimal outcomes.
• Work collaboratively with members’ Child and Family Teams.
• Escalate quality-of-care issues through established channels.
• Use negotiation and motivational interviewing to secure services and promote member engagement and behavior change.
• Provide coaching and support to empower members to make independent medical and healthy lifestyle choices and participate in healthcare decision-making.
• Serve as a single point of contact for members to remediate immediate and acute gaps in care and access.
• Ensure compliance with regulatory and accreditation guidelines, company policies, and quality management processes.

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, youth, and their families/caregivers.
• 2+ years of experience in one or more of the following: 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 reimbursed per company policy.
• Willing and able to work beyond core business hours as needed.
• Bachelor’s degree or non-licensed master-level clinician required.
• Must reside in Ohio.

Qualifications

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

Education

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

Pay

The typical pay range for this role is $21.10 – $40.90 per hour. The actual base salary will vary based on 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.