Care Plan Reviewer- OhioRISE

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Position Summary

The Care Plan Reviewer (Clinical Case Manager BH) utilizes advanced clinical judgment and critical

thinking skills to supports appropriate member behavioral healthcare through review of assessment

and care planning documentation and consultation with care coordinators to support psychosocial

wraparound services to promote effective utilization of available resources and optimal, cost-effective

outcomes.

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.

Responsibilities include:

• Be clinically and culturally competent/responsive with training and experience necessary to

provide clinical consultation for members complex need across child-serving systems.

• Assessment of Member's Child and Family-Centered Care Plans and Crisis and Safety Plan:

o Through the use of clinical tools and information/data review, review assessments of

member's needs and determines approach to meeting needs by evaluating

comprehensiveness of member's Child and Family-Centered Care Plans.

o Applies clinical judgment to the incorporation of strategies designed to reduce risk

factors and address complex clinical indicators which impact care planning and

resolution of member issues.

o Using advanced clinical skills, review crisis and safety plans for members experiencing a

behavioral health need to support appropriate individualized trauma-informed

interventions and de-escalation strategies.

• Enhancement of Medical Appropriateness and Quality of Care:

o Application and/or interpretation of applicable criteria and clinical guidelines, policies,

procedures, and regulatory standards while completing reviews and prior approvals to

assess member's needs to ensure timely administration of benefits.

o Using holistic approach consults with supervisors, Medical Directors and/or other

programs to overcome barriers to meeting goals and objectives; presents cases at case

conferences to obtain multidisciplinary view in order to achieve optimal outcomes.

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

o Ability to speak to medical and behavioral health professionals to influence appropriate

member care.

o Utilizes motivational interviewing skills to provide coaching to care coordination staff

and supervisors to support the child and family-centered care planning process

consistent with System of Care Principles and High-Fidelity Wraparound practice.

o Provides coaching, information and support to empower the member to make ongoing

independent medical and/or healthy lifestyle choices.

o Analyzes all utilization, self-report and clinical data available to consolidate information

and begin to identify comprehensive member needs.

Required Qualifications

• Unencumbered Behavioral Health clinical license in Ohio is required (LMFT, LSW, LPC).

• 2+ years of experience in children's mental health, child welfare, developmental disabilities,

juvenile justice, or a 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.

• 1+ year(s) of experience with personal computers, keyboard, multi-systems navigation, and

MS Office Suite applications.

• Willing and able to travel in-state up to 10% of the time with a personal vehicle.

Preferred Qualifications

• LPCC, IMFT, LISW licenses are preferred.

• 3+ years of direct clinical practice experience post-Master's degree, e.g., hospital setting or

alternative care setting such as ambulatory care or outpatient clinic/facility.

• Managed care/utilization review experience.

• Case management and discharge planning experience

Education

• Minimum of a Master's degree in Counseling, Social Work, or Marriage and Family Therapy is required

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

The typical pay range for this role is:

$60,522.00 - $129,615.00

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.


Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 05/31/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.