Care Management Coordinator OhioRISE – Field – Must reside West Region of Ohio

About the role

Must reside in West Region Ohio Counties: Hamilton, Clermont, Butler, Warren, Hardin, Logan, Champaign, dams, Brown, Scioto, Darke, Greene, Clinton, Miami, Montgomery, Preble, Lucas, Fulton, Williams, Defiance, Van Wert, Hardin, Mercy, Green, Clark, Madison, Auglaize, Allen, Logan, Shelby.

This is a full-time field-based telework position, in Ohio. This position requires the ability to travel within the assigned region of Western Ohio to member homes and other requested member locations, up to 50% or more of the time. Monday-Friday 8-5pm with flexibility needed to work later to meet member needs.

Responsibilities

• Evaluate members through the use of care management tools and information/data review, conducting comprehensive evaluations of referred member's needs/eligibility and recommending approaches 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 referrals to clinical case management or crisis intervention as needed.
• Coordinate and implement assigned care plan activities and monitor care plan progress.
• Enhance medical appropriateness and quality of care by consulting with case managers, supervisors, Medical Directors, and 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.
• Collaborate 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, and utilize 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, and serve as a single point of contact for members and assist them in remediating 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

• 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 Ohio delivery systems, including local community networks and resources.
• Must reside in the West Region of Ohio; Counties include Hamilton, Clermont, Butler, Warren, Hardin, Logan, Champaign, dams, Brown, Scioto, Darke, Greene, Clinton, Miami, Montgomery, Preble, Lucas, Fulton, Williams, Defiance, Van Wert, Hardin, Mercy, Green, Clark, Madison, Auglaize, Allen, Logan, Shelby.
• 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.

Qualifications

• Bachelor’s degree or 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).

Skills

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

Benefits

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. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.