CVS Health
Care Management Coordinator OhioRISE (North East Region)
CVS Health, Frankfort, Kentucky, United States
Care Management Coordinator OhioRISE (North East Region)
– CVS Health Position Summary : This is a full‑time field‑based telework position, in Ohio. The role requires the ability to travel within the assigned region of Northeast Ohio to member homes and other requested member locations, up to 25% or more of the time. Applicants must reside within the Northeast region; candidates residing in Cuyahoga County are strongly preferred. Monday‑Friday 8‑5 pm with flexibility needed to work later to meet member needs.
Business Overview 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.
Fundamental Components – 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 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 knowledgeably participate with their provider in healthcare decision‑making.
Serves a single point of contact for members and assists 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.
Required Qualifications
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 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.
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. Mileage is reimbursed per our company expense reimbursement policy.
Willing and able to work beyond core business hours of Monday‑Friday, 8 am‑5 pm, as needed.
Preferred Qualifications
Case management and discharge planning experience.
Managed Care experience.
Medicaid experience.
Education Essentially a bachelor’s degree or a non‑licensed master’s level clinician required, with either degree being in behavioral health, human services, health services, or public health preferred (i.e., psychology, social work, marriage and family therapy, counseling, juvenile justice).
Anticipated Weekly Hours 40
Time Type Full time
Pay Range The Typical Pay Range For This Role Is
$21.10 – $36.78. 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.
Great Benefits For Great People
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No‑cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 01/30/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr
– CVS Health Position Summary : This is a full‑time field‑based telework position, in Ohio. The role requires the ability to travel within the assigned region of Northeast Ohio to member homes and other requested member locations, up to 25% or more of the time. Applicants must reside within the Northeast region; candidates residing in Cuyahoga County are strongly preferred. Monday‑Friday 8‑5 pm with flexibility needed to work later to meet member needs.
Business Overview 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.
Fundamental Components – 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 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 knowledgeably participate with their provider in healthcare decision‑making.
Serves a single point of contact for members and assists 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.
Required Qualifications
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 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.
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. Mileage is reimbursed per our company expense reimbursement policy.
Willing and able to work beyond core business hours of Monday‑Friday, 8 am‑5 pm, as needed.
Preferred Qualifications
Case management and discharge planning experience.
Managed Care experience.
Medicaid experience.
Education Essentially a bachelor’s degree or a non‑licensed master’s level clinician required, with either degree being in behavioral health, human services, health services, or public health preferred (i.e., psychology, social work, marriage and family therapy, counseling, juvenile justice).
Anticipated Weekly Hours 40
Time Type Full time
Pay Range The Typical Pay Range For This Role Is
$21.10 – $36.78. 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.
Great Benefits For Great People
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
No‑cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 01/30/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr