Clinical Case Manager BH - CME Support (Northeast) - OhioRISE
Location: New Albany, Ohio
Internal Number: 1966261BR
Job Description Business Overview As part of the bold vision to deliver the âœNext Generationâ 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.
This is a full time telework position in Ohio, with travel required. The Clinical Case Manager BH utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. This position will support and work closely with Care Management Entities (CME) in the assigned region. Travel will be required to CME offices and other member locations within the assigned region. Additional responsibilities will include auditing and supporting data exchange for CME oversight.
â¢ Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems.
â¢ Assessment of Members: o Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. 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, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated. o Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services. â¢ Enhancement of Medical Appropriateness and Quality of Care: o Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate 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 ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health. o Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices. o Helps member actively and knowledgably participate with their provider in healthcare decision-making. o Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs. â¢ Monitoring, Evaluation and Documentation of Care: o In collaboration with the member and their care team develops and monitors established plans of care to meet the member's goals. o Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Required Qualifications â¢ Must reside in Ohio. â¢ Unencumbered Behavioral Health clinical license in Ohio. (LPCC, IMFT, LISW) â¢ 3+ years of direct clinical practice experience post Master's degree. â¢ 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. â¢ 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. â¢ 1+ year(s) of experience with personal computer, keyboard and multi-systems navigation, and MS Office Suite applications (Word, Outlook, Excel, SharePoint). â¢ Willing and able to travel up to 20% of the time in the assigned region. Must possess reliable transportation, valid/active driverâ™s license, and proof of vehicle insurance. â¢ Willing and able to work beyond core business hours of Monday-Friday, 8am-5pm.
COVID Requirements CVS Health requires its Colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, or religious belief that prevents them from being vaccinated.
If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.
Preferred Qualifications â¢ Crisis intervention skills. â¢ Managed care/utilization review experience. â¢ Case management and discharge planning experience.
Education â¢ Masters degree in social work, counseling, or marriage and family therapy with an independent practice license in Ohio, LISW, LPCC, or IMFT required
Business Overview At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.
At CVS Health, we work every day to help people on their path to better health. Never has it been more important for us to deliver on our purpose to our valued customers, patients, members, and employees. With a presence in communities across the country, CVS Health colleagues are and will continue to be a critical piece of the country’s health care solution. The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together. If you would like to learn about the actions we are taking as a company as we learn more about COVID-19 and its spread, we encourage you to visit our COVID-19 resource center at https://cvshealth.com/covid-19
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to... attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. Please note that we only accept applications for employment via this site.
We provide reasonable accommodations to qualified individuals with disabilities. If you need to request an accommodation, a qualified interpreter, written information in other formats, translation or other services, please contact our Advice and Counsel Reasonable Accommodations team by emailing Advice and Counsel Reasonable Accommodations team or calling 877-805-9511.
If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or email@example.com. For technical issues with the Virtual Job Tryout, contact the Modern Hire Help Desk at 1-877-451-1695 or firstname.lastname@example.org.