Care Management Coordinator North East Region OhioRISE Must live in Seneca Wyandot or Crawford County

At CVS Health were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nations leading health solutions company we reach millions of Americans through our local presence digital channels and more than 300000 purposedriven colleagues caring for people where when and how they choose in a way that is uniquely more connected more convenient and more compassionate. And we do it all with heart each and every day.

Position Summary

This is a fulltime fieldbased telework position in Ohio. This position requires the ability to travel within the assigned region of Northeast Ohio to member homes and other requested member locations 50 of the time or more.

Applicants may reside within the Northeast region or counties located adjacent to the region. Strongly prefers candidates to reside in Seneca Wyandot or Crawford County.

MondayFriday 85pm 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 childserving 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 preferably Cuyahoga county.

Fundamental Components:

Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across childserving systems.

Evaluation of Members:

• Through the use of care management tools and information/data review conducts comprehensive evaluation of referred members needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members 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.
• Coordinates and implements assigned care plan activities and monitors care plan progress.

Enhancement of Medical Appropriateness and Quality of Care:

• 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.
• Works collaboratively with the members Child and Family Teams.
• Identifies and escalates quality of care issues through established channels.
• Utilizes negotiation skills to secure appropriate options and services necessary to meet the members benefits and/or healthcare needs.
• Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provides coaching information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgably participate with their provider in healthcare decisionmaking.
• 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:

• 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 multisystem navigation and MS Office Suite applications (Outlook Word Excel SharePoint).
• 2 years of experience in childrens mental health child welfare developmental disabilities juvenile justice or a public sector human services or behavioral health care field providing communitybased services to children and youth and their family/caregivers.
• 2 years 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 year of experience with Ohio delivery systems including local community networks and resources.
• Willing and able to travel within the assigned region 50 of the time or more; Some travel to the New Albany office may be required for trainings/meetings:
• Reliable transportation required
• Mileage is reimbursed per our company expense reimbursement policy
• Willing and able to work beyond core business hours of MondayFriday 8am5pm as needed.

Preferred Qualifications

• Case management and discharge planning experience.
• Managed Care experience.
• Medicaid experience.
• Candidates to reside in Seneca Wyandot or Crawfor County

Education

Bachelors degree or nonlicensed master level clinician required with either degree being in behavioral health human services health services or public health preferred.(i.e. psychology social work marriage and family therapy counseling juvenile justice).

In addition to your compensation enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical dental and vision benefits. Eligible employees may enroll in the Companys 401(k) retirement savings plan and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fullypaid term life insurance plan to eligible employees and shortterm and long term disability benefits. CVS Health also offers numerous wellbeing programs education assistance free development courses a CVS store discount and discount programs with participating partners. As for time off Company employees enjoy Paid Time Off (PTO) or vacation pay as well as paid holidays throughout the calendar year. Number of paid holidays sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits please visit

Health is committed to recruiting hiring developing advancing and retaining individuals with disabilities. As such we strive to provide equal access to the benefits and privileges of employment including the provision of a reasonable accommodation to perform essential job functions. CVS Health colleagues can initiate a request for a reasonable accommodation including a qualified interpreter written information in other formats translation or other services through myHRor through myLeave at myHR). If you have a speech or hearing disability please call 711 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.

CVS Health requires certain colleagues to be fully vaccinated against COVID19 (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 COVID19 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.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual fulltime 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 shortterm 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 our comprehensive and competitive mix of pay and benefits investing in the physical emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages our great benefits include:

• Affordable medical plan options a 401(k) plan (including matching company contributions) and an employee stock purchase plan.

• Nocost programs for all colleagues including wellness screenings tobacco cessation and weight management programs confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off flexible work schedules family leave dependent care resources colleague assistance programs tuition assistance retiree medical access and many other benefits depending on eligibility.

For more information visit anticipate the application window for this opening will close on: 04/30/2025

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