Care Plan Reviewer- OhioRISE

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 Members 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

members needs and determines approach to meeting needs by evaluating

comprehensiveness of members 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 members 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 childrens 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-Masters 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 Masters degree in Counseling Social Work or Marriage and Family Therapy is required