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Job Details

CVS Health

Case Management Coordinator (Northeast) - OhioRISE (1966283BR)





New Albany, Ohio, United States

Job Description
Qualifying candidates may be eligible for a sign-on bonus of up to $3,000.

Business Overview
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.

This is a full-time field-based telework position, in Ohio. This position requires the ability to travel with personal vehicle within the assigned region to member homes and other requested member locations, up to 35% of the time. 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
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
• 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.
• 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.
• Experience with Ohio delivery systems, including local community networks and resources.
• Willing and able to travel within the assigned region up to 35% of the time; travel is with personal vehicle, must possess reliable transportation, valid/active driver’s license, and proof of vehicle insurance. Some travel to the New Albany office may be required for trainings/meetings.
• Willing and able to work beyond core business hours of Monday-Friday, 8am-5pm, as needed.

COVID Requirements

COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

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

• 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).

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.