Care Plan Reviewer

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Evaluate member assessments and Child and Family-Centered Care Plans.

• Assess crisis and safety plans for members facing behavioral health challenges.

• Utilize clinical judgment to mitigate risk factors and address intricate clinical indicators.

• Implement clinical criteria, guidelines, policies, procedures, and regulatory standards during reviews and prior approvals.

• Collaborate with supervisors, Medical Directors, and other programs to navigate care obstacles.

• Present cases at multidisciplinary case conferences.

• Recognize and escalate quality-of-care concerns.

• Engage with medical and behavioral health professionals to promote suitable member care.

• Mentor care coordination staff and supervisors using motivational interviewing techniques.

• Offer information and support to empower members towards independent medical decisions and healthier lifestyle choices.

• Examine utilization, self-report, and clinical data to determine comprehensive member needs.

• Facilitate behavioral healthcare for children with serious or complex needs through coordinated OhioRISE services.

⛳️ Requirements

• An unencumbered Behavioral Health clinical license in Ohio is mandatory (LMFT, LSW, LPC).

• A minimum of 2 years of experience in children's mental health, child welfare, developmental disabilities, juvenile justice, or within a human services or behavioral health care field, delivering community-based services to children and youth and their families/caregivers.

• Proficient in family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development.

• At least 1 year of experience with personal computers, keyboarding, multi-systems navigation, and MS Office Suite applications.

• Must be willing and able to travel within the state up to 10% of the time using a personal vehicle.

• A minimum of a Master's degree in Counseling, Social Work, or Marriage and Family Therapy is required.

• LPCC, IMFT, or LISW licenses are preferred.

• Over 3 years of direct clinical practice experience post-Master's degree is preferred.

• Experience in managed care/utilization review is preferred.

• Background in case management and discharge planning is preferred.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being.

• CVS Health bonus, commission, or short-term incentive program in addition to base pay.