Pediatric Care Coordination Specialist – Ohio (Hybrid)

CVS Health; Kettering (OH); Remote; USD 44,000 - 85,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is hiring a field-based Case Management Coordinator in Ohio to support children and families within the OhioRISE program. You’ll travel across Western Ohio up to 50% to member homes and locations, coordinating care and education to improve health outcomes.

The role requires a strong background in behavioral health, experience with MS Office, and the ability to work flexible hours beyond the standard 8–5 schedule. Travel and statewide collaboration are essential to success.

Qualifications

• 2+ years of experience in behavioral health, social services, or human services.
• 2+ years of experience with personal computers, keyboard and 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, providing community-based 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.
• Must reside in the West Region of Ohio; Counties include Butler, Hamilton, Clermont, Warren, Montgomery, Allen, Hardin, Defiance, or Lucas
• 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.
• 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 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

Behavioral health

MS Office

Ohio Medicaid knowledge

Travel readiness

Community collaboration

Education

Bachelor's or Master's in behavioral health/related field

Tools

Outlook

Word

Excel

SharePoint

Job description

CVS Health is hiring a field-based Case Management Coordinator in Ohio to support children and families within the OhioRISE program. You’ll travel across Western Ohio up to 50% to member homes and locations, coordinating care and education to improve health outcomes.

The role requires a strong background in behavioral health, experience with MS Office, and the ability to work flexible hours beyond the standard 8–5 schedule. Travel and statewide collaboration are essential to success.