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Position Summary

The primary goals of the Aetna care coordination program are to improve care coordination; increase access to home and community-based care; increase access to natural supports; equip children, adolescents, and families with the skills needed to manage their care; improve youth and family outcomes; and reduce the cost of behavioral health social services. Our program facilitates the seamless delivery of high-quality, person-centered, trauma informed care and services for our members. Additionally, our program ensures that the care and services members receive aligns with their preferences, needs, and goals, utilizing motivational interviewing to optimize their self-empowerment and self-sufficiency.

Our care coordination team partners with members, providers, caregivers, care management entities (CMEs), managed care organizations (MCOs) and other child-serving support systems. Each member’s characteristics and potential barriers associated with social determinants of health (SDOH) are considered when addressing behavioral health, functional and social (biopsychosocial) needs to support improved outcomes. Our regionally based case management coordinators (care coordinators) utilize critical thinking and judgment to collaborate and inform the care coordination process, in order to facilitate

Position Responsibilities:

• Uses care management tools and information/data review and 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 Child and Family-Center Care Plan (CFCP) activities and monitors care plan progress to ensure that services are delivered as recommended in the CFCP.

• Using a 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 as a single point of contact for members and assists members to remediate immediate and acute gaps in services and access.

• Monitors, evaluates, and documents care utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

• Identifies, refers, and links members to behavioral health network providers and social supports as needed (e.g., scheduling appointments, arranging transportation).

• Assists in the coordination of member access to MCO covered services as needed by linking to MCO (e.g., linking the member to MCO health education, disease management, and health and wellness programs).

• Educates members about available resources and services (e.g., OhioRISE Plan value-added benefits) and assisting the member in accessing those resources and services.

• Communicates and exchanges information across relevant child-serving systems (e.g., child welfare case worker, school) consistent with appropriate releases of information signed by the member/guardian.

• Shares care coordination data and information with ODM, the members' MCO, and the state’s single pharmacy benefits manager (SPBM) as applicable to prevent gaps in care and duplication of efforts.

• Facilitaties clinical hand offs during transitions of care including pending members, new members, between Aetna and CMEs, CME to CME, and care coordinator to care coordinator.

• Required Qualifications

• Must reside in the state of Ohio; Preferred counties: Lucas and surrounding counties, Montgomery and surrounding counties, Hamilton and surrounding counties

• Ability to travel up to 50%

• 2+ 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.

• 3+ 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

• 3 years experience clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems.

• Experience using a computer and strong keyboard navigation skills including the use of MS Office Suite, Word, and Excel applications.

Preferred Qualifications

• Case management and discharge planning experience preferred.

• Managed Care experience preferred.

• Preferred skills: Mental Health First Aid, Trauma Informed Care, HIPAA, C.L.A.S. Standards

Education

• Bachelor's degree or non-licensed master level clinician required, with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling)

Pay Range

The typical pay range for this role is:

$19.52 - $40.90

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 07/03/2024

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.