Care Management Coordinator OhioRISE - Field - Must reside NW/West Region of Ohio

Position Summary Must reside in West Region Ohio Counties: counties include Defiance, Lucas, Paulding, Putnam, Williams, Fulton, Harden, Allen, or Auglaize. The following counties may also be considered: Mercer, Shelby, Logan, Darke, Miami, Clark, Preble. This is a full‑time field‑based telework position in Ohio. The role requires travel within the assigned region of Western Ohio to member homes and other requested locations up to 50% or more of the time. Monday‑Friday 8‑5 pm with flexibility needed to work later to meet member needs. Business Overview 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. Responsibilities Utilize critical thinking and judgment to collaborate and inform the case‑management process, to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education through care‑management tools and resources. Evaluate members using care‑management tools and data review, conduct comprehensive evaluation of referred member’s needs/eligibility, and recommend an approach to case resolution or meeting needs, assessing 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 referral to clinical case management or crisis intervention as appropriate. 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/or other health/behavioral health programs to overcome barriers, presenting cases at case conferences for multidisciplinary review to achieve optimal outcomes. Work collaboratively with the members’ child and family teams, identifying and escalating quality of care issues through established channels. Utilize negotiation skills to secure appropriate options and services needed to meet the member’s benefits and/or healthcare needs. Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum health outcomes. Provide coaching, information, and support to empower members 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 to remediate 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. 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. 2+ years experience in one or more of the following areas: family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development. 2+ years experience with Ohio delivery systems, including local community networks and resources. Must reside in the West Region of Ohio; counties include Butler, Hamilton, Clermont, Warren, Montgomery, Allen, Hardin, Defiance, or Lucas. Willing and able to travel within the assigned region up to 50% of the time; reliable transportation required; mileage reimbursed per company expense policy. Willing and able to work beyond core business hours of Monday‑Friday 8‑am‑5‑pm, as needed. Preferred qualifications: case‑management and discharge planning experience; managed care experience; Medicaid experience. Bachelor’s degree or master level clinician required, with either degree being in behavioral health, human services, health services, or public health preferred (e.g., psychology, social work, marriage and family therapy, counseling, juvenile justice). Benefits Full‑time position eligible for a comprehensive benefits package that includes medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources (subject to eligibility). EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr 4004 Aetna Medicaid Administrators