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.The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. Must reside in Ohio.Fundamental Components:

• Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems.

• Evaluation of Members:

o 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.

o Coordinates and implements assigned care plan activities and monitors care plan progress.• Enhancement of Medical Appropriateness and Quality of Care:

o 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.

o Works collaboratively with the members' Child and Family Teams.

o Identifies and escalates quality of care issues through established channels.

o Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.

o Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.

o Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

o Helps member actively and knowledgably participate with their provider in healthcare decision-making.

o 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:

o Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

• 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.

• 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.

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 (i.e. psychology, social work, marriage and family therapy, counseling, juvenile justice).Pay Range

The typical pay range for this role is:$21.10 - $36.78This 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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS HealthWe anticipate the application window for this opening will close on: 12/31/2024Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.