Analyst, Case Management - OhioRISE - Must reside in the Northeast Region of OH

Analyst, Case Management - OhioRISE - Must reside in the Northeast Region of OH

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose‑driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

This is a full‑time field‑based telework position, in Ohio. The position requires the ability to travel within the assigned region of Northeast Ohio to member homes and other requested member locations, up to 50% or more of the time. Applicants may reside within the Northeast region of Ohio, with a strong preference for candidates to reside in Stark, Columbiana, Belmont, Jefferson, Marion, or Ottawa County. Hours are Monday‑Friday 8‑5pm 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. 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. Must reside in Ohio.

Fundamental Components

• Be clinically and culturally competent / responsive with training and experience necessary to manage complex cases in the community across child‑serving systems.
• Conduct comprehensive evaluation of referred member's needs / eligibility and recommend an approach to case resolution using care management tools and information / data review. 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.
• Using a holistic approach, consult with case managers, supervisors, Medical Directors and other health / behavioral health programs to overcome barriers to meeting goals and objectives; present cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
• Work collaboratively with the members' Child and Family Teams.
• Identify and escalates 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 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.
• Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Qualifications

Preferred Qualifications

Candidate Location

Candidate will reside in Stark, Columbiana, Belmont, Jefferson, Marion or Ottawa County.

Education

Bachelor’s degree or non‑licensed master 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

$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.

Benefits

For more information, visit https : / / jobs.cvshealth.com / us / en / benefits.

We anticipate the application window for this opening will close on : 11 / 28 / 2025.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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