OhioRISE Case Manager - Regional (NE/NW/SE)

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. Position Summary This is a full‑time field‑based telework position located in Ohio. The role requires the ability to travel within the assigned region of Northeast Ohio to member homes and other requested member locations, up to 50% or more of the time. Applicants may reside within the Northeast region of Ohio. The role strongly prefers candidates who reside in any of the following counties: Summit, Stark, Medina, Lorain, Portage, Geauga, Lake, Ashtabula, Cuyahoga, Marion, Wyandot, Crawford, Sandusky, Huron, Belmont, Jefferson, Harrison County. Work week is Monday‑Friday 8:00–17:00 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. 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: Through the use of care management tools and information/data review, conduct a comprehensive evaluation of referred member's needs/eligibility and recommend an approach to case resolution and/or meeting needs by evaluating 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. Enhancement of Medical Appropriateness and Quality of Care: Using a holistic approach consult with case managers, supervisors, Medical Directors and/or other health/behavioral health programs to overcome barriers to meeting goals and objectives; present cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes. Work collaboratively with the members' Child and Family Teams. Identify and escal ate quality of care issues through established channels. Utilize negotiation skills to secure appropriate options and services necessary 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 level of health. Provide coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. Help member actively and knowledgably participate with their provider in healthcare decision‑making. Serve as 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: Utilize 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. 2+ years of 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+ years 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 company expense reimbursement policy. Willing and able to work beyond core business hours Monday‑Friday 8:00–17:00, as needed. Preferred Qualifications Case management and discharge planning experience. Managed Care experience. Medicaid experience. Candidate will reside in Summit, Stark, Medina, Lorain, Portage, Geauga, Lake, Ashtabula, Cuyahoga, Marion, Wyandot, Crawford, Sandusky, Huron, Belmont, Jefferson, Harrison County. 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 preferred (e.g. psychology, social work, marriage and family therapy, counseling, juvenile justice). Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $21.10 - $40.90. This 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. Great benefits for great people This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr Arc's Assistive Technology (at) Services