Care Management Coordinator Field OhioRISE NorthEast reside in Ohio

Position Summary

This is a full‑time field‑based and telework position, in Northeast Ohio. This position requires the ability to travel within the assigned region of Ohio to member homes and other requested member locations, up to 50% or more of the time. Applicants must reside in the northeast region of Ohio.
Highly Preferred Counties for applicant to reside in:
Summit and Stark. Additional referred counties include:
Ashtabula, Crawford, Huron, Lake, Lorain, Marion, Ottawa, Sandusky, and Seneca. Must reside in Ohio.

Work hours Monday‑Friday 8‑5pm with flexibility needed to work later to meet member needs.

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 child‑serving 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.

• 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, conduct comprehensive evaluation of referred member’s needs/eligibility and recommend an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identify 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.
  • Coordinate and implement assigned care plan activities and monitor care plan progress.
• Enhancement of Medical Appropriateness and Quality of Care:
  • Using a holistic approach, consult with case managers, supervisors, Medical Directors and/or other health/behavioral health programs to overcome barriers to meeting goals and objectives; present cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes.
  • Work collaboratively with the members’ Child and Family Teams.
  • Identify and elevate quality of care issues through established channels.
  • Utilize negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
  • Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
  • Provide coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
  • Help the member actively and knowledgeably participate with their provider in healthcare decision‑making.
  • Serve as 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:
  • Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

• 2+ years of experience in behavioral health, social services, or human services.
• 2+ years of experience with personal computers, keyboard and multi‑system navigation, 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…