CVS Health Hiring for Regional Coordinator (WEST REGION) at New Albany, OH Full Time

This is a full time telework position in Ohio. Regional Coordinators (BH Clinical Case Managers) develop and execute OhioRISE engagement activities in priority communities. This position 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. Regional Coordinators routinely travel to member homes, other member locations, and provider locations, 10-20% of the time. Travel is in-state within the assigned region.

Fundamental Components:

• 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.

• 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 – 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 – Identifies and escalates quality of care issues through established channels -Ability to speak to medical and behavioral health professionals to influence appropriate member care.

o Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes 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.

o Helps member actively and knowledgably participate with their provider in healthcare decision-making -Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.

• 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 -Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Specific to the OHRise contract, responsibilities include but are not limited to:

a. Serve as the OhioRISE Plan’s primary points of contact for ODM-approved improvement efforts involving community-based organizations and requiring community outreach and active involvement in priority communities (e.g., juvenile detention diversion initiatives or reduction in efforts to reduce out–of-home placements);

b. Serve as the OhioRISE Plan’s dedicated contact for county or local child serving agencies. Attend or oversee OhioRISE Plan attendance at community events in priority communities (e.g., trainings; County Alcohol Drug and Mental Health Boards [ADAMH], Boards of Developmental Disability, PCSA, Family and Children First Councils, Juvenile Courts, and School District meetings; and racism dialogues);

c. Provide in-person communication with ODM or other state agency funded community-based organizations in order to bolster the presence of the OhioRISE Plan itself as a collaborative and trusted partner of the community-based organization and as a supporter of the ODM initiative;

d. Coordinate training for county or local child-serving entities regarding the roles and responsibilities of the OhioRISE Plan and the CMEs;

e. Collaborate with the CMEs to identify service and resource gaps in local communities and assist state and local child-serving agencies in addressing those gaps;

f. Collaborate with MCO’s Regional Coordinators to collectively strategize and address community concerns;

g. Coordinate the tracking and submission of process measures, as needed, related to OhioRISE Plan’s improvement efforts in communities (e.g., reductions in out-of-home placements);

h. Promote the referral of members to community-based organizations when services are provided that will promote better outcomes;

i. Respond to ODM inquiries related to OhioRISE Plan’s community engagement activities; and

j. Build alliances with family- and youth-run organizations to strengthen family and youth voice in OhioRISE Plan’s operations.

Required Qualifications

• Must reside in Ohio.
• Unencumbered Behavioral Health clinical license in Ohio (e.g. LSCW LICSW, LPC, LPCC)
• Must have at least two years’ experience in a setting that includes services or management of multi-system youth, work with local/community systems of care, and knowledge of Ohio’s child-serving systems.
• Minimum of two years’ experience in children’s mental health, child welfare, developmental disabilities, juvenile justice, or a related public sector human services or behavioral health care field, providing community-based services to children and youth, and their family/caregivers;
• Background and 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; and
• Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems.
• 3+ years of direct clinical practice experience post Master’s degree, e.g., hospital setting or outpatient clinic/facility.
• Demonstrated proficiency with personal computers, keyboard and multi-systems navigation, and MS Office applications.
• Ability to travel with personal vehicle; must have reliable transportation, valid/active drivers license, and proof of vehicle insurance
• Flexible to work outside core hours, Mon-Fri, 8-5, is required.

Preferred Qualifications

• Crisis intervention skills preferred.
• Medicaid and managed care experience preferred.
• Case management and discharge planning experience preferred.

Education

• Minimum of a Masters’ degree in Behavioral/Mental Health or related field.

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.