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Position Summary

As part of the bold vision to deliver the "Next Generation" of managed care in Ohio Medicaid, Ohio RISE 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.

• Adheres to compliance with policies and procedure/regulatory standards.
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Responsible for initial review and triage of care team tasks and ongoing management of Care Plan Review tasks.
• Supports the development, implementation, and follow-up of care plans.
• Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., providers, and health care team members respectively).
• Enter and maintain member records in electronic health record system, compile reports and complete other program documentation in a timely manner (e.g., progress notes, letters), and other administrative responsibilities as needed.
• Completes documentation in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency.
• Provides non-medical research including eligibility verification, COB and benefits verification.
• Communicate with Aetna internal teams when processing transitions for members active in this program.

• Effective communication and organization skills with ability to be agile, managing multiple priorities at one time, and adapting to change with enthusiasm.
• Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification, and resolution of issues to promote positive outcomes for members, adhering to care management processes (to include, but not limited to, privacy and confidentiality, quality management processes in compliance with regulatory, accreditation guidelines, company policies and procedures).
• Completes documentation of each member call in the electronic record, thoroughly completing required actions with a high level of detail to ensure compliance requirements are met with efficiency.
• Works independently and competently, meeting deliverables and deadlines while demonstrating an outgoing, enthusiastic, and caring presence.
• Experience with computers including knowledge of Microsoft Word, Outlook, and Excel - data entry and documentation within member records.
• Strong organizational skills, including effective verbal and written communication skills.

• 2+ years experience in healthcare field (i.e., experienced in medical office, hospital setting) preferred.
• Familiarity with basic behavioral medical terminology and concepts used in care management preferred.

• High School diploma, G.E.D. or equivalent.