Care Management Coordinator OhioRISE - Field - Central/SE Ohio

About the role

This is a full-time field-based telework position in Ohio. The role requires travel within the assigned region of Central and Southeast Ohio to member homes and other requested member locations, up to 50% or more of the time. Applicants may reside within the Central/SE care coordination region of Ohio, with strong preference for candidates to reside in one of the following counties: Fairfield, Licking, Muskingum, Perry, Pickaway, Hocking, Fayette, Ross, Richland, Highland, Franklin. 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 bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, OhioRISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.

Responsibilities

• Conduct comprehensive evaluation of referred member’s needs/eligibility and recommend an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
• Identify 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 needed.
• Coordinate and implement assigned care plan activities and monitor care plan progress.
• Consult with case managers, supervisors, Medical Directors and/or other health/behavioral health programs to overcome barriers to meeting goals and objectives; present cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Work collaboratively with the members’ Child and Family Teams.
• Identify and escalate quality of care issues through established channels.
• Utilize negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
• Use influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provide coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Help members actively and knowledgeably participate with their provider in healthcare decision-making.
• Serve as a single point of contact for members and assist members to remediate immediate and acute gaps in care and access.
• Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Requirements

• Bachelor’s degree or non-licensed master level clinician required.
• 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 in 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 company expense reimbursement policy.
• Willing and able to work beyond core business hours of Monday–Friday, 8 am–5 pm, as needed.

Preferred 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 being 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 offer will depend 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 range listed above.

Benefits

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. Benefits include medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources, based on eligibility.