Care Management Coordinator OhioRISE - Field - Northeast/Northwest Region Ohio

About the role

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This is a full-time field-based telework position, in Ohio. This position requires the ability to travel within the assigned region of Northeast/Northwest Ohio to member homes and other requested member locations, up to 50% or more of the time. Applicants may reside within the northeast/northwest region of Ohio. Strongly prefers candidates to reside in one of the following counties: Cuyahoga, Summit, Medina, Portage, Marion, Wyandot, Crawford, Sandusky, Stark, Belmont, Jefferson, Huron, Harrison, Lake, Geauga, Lorain, or Ashtabula. Monday‑Friday 8‑5pm with flexibility needed to work later to meet member needs.

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.
• Coordinates and implements assigned care plan activities and monitors care plan progress.
• Enhancement of Medical Appropriateness and Quality of Care: Using 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.
• Works collaboratively with the members' Child and Family Teams.
• Identifies and escalates quality of care issues through established channels.
• Utilizes 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 knowledgably participate with their provider in healthcare decision‑making.
• Serves a single point of contact for members and assist members to remediate immediate and acute gaps in care and access.
• Monitoring, Evaluation and Documentation of Care: Utilizes 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 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+ year 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