Field Case Manager – Pediatric Behavioral Health (Ohio)

CVS Health Corporation; Fremont (OH); Remote; USD 29,000 - 56,000; Full time

Benefits offered by this job

Mileage reimbursement

Job summary

CVS Health Corporation seeks a Case Management Coordinator in Ohio to support the OhioRISE program through field-based telework with regional travel up to 50%. The role centers on coordinating care, evaluating member needs, and guiding families through complex behavioral health services.

Applicants should have a behavioral health degree and 2+ years of related experience, including child services, with Ohio delivery system knowledge.

Qualifications

• Bachelor’s degree or non-licensed master level clinician required.
• 2+ years of experience in behavioral health, social services, or human services.
• 2+ years of experience with 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.
• 2+ years experience in family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development.
• 2+ years 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
• Willing and able to work beyond core business hours of Monday-Friday, 8am-5pm, as needed.

Responsibilities

• 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, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's 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.
• 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 member's 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 decision-making.
• 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.

Skills

Travel up to 50%

Care coordination

Documentation

Education

Bachelor’s degree or non-licensed master in behavioral health

Tools

MS Office Suite

Job description

CVS Health Corporation seeks a Case Management Coordinator in Ohio to support the OhioRISE program through field-based telework with regional travel up to 50%. The role centers on coordinating care, evaluating member needs, and guiding families through complex behavioral health services.

Applicants should have a behavioral health degree and 2+ years of related experience, including child services, with Ohio delivery system knowledge.