Transition of Care Coordinator - Manager - OhioRISE
CVS Pharmacy - New Albany, OH
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Job DescriptionAs part of the bold vision to deliver the “Next Generation†of managed care in Ohio Medicaid, Ohio RISE 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.This is a WFH position. Must reside in Ohio. The Transition of Care Coordinator is responsible for oversight and management of clinical team processes including the organization and development of high performing teams. Specific to the OhioRISE contract, responsibilities include but are not limited to:1. Serves as the primary point of contact with MCOs and with state agency staff for planning, managing, and troubleshooting transition issues as members' transition from MCOs into the OhioRISE Plan or back to the MCOs. The position reports to the Director of Care Coordination and must serve as the OhioRISE Plan's primary point of contact for planning and managing all member transitions of care as identified in Appendix D, Care Coordination, and transitions resulting from OhioRISE Plan's enrollments and disenrollments.2. The primary functions of the OhioRISE Plan's Transition of Care Coordinator include but are not limited to: a. Development of OhioRISE Plan's policies and procedures for successful transition of members to and from MCOs in alignment with state requirements;b. Primary point of contact for OhioRISE Plan's staff, ODM, MCO representatives, and other state agency staff for transition of care issues; andc. Interface with Regional Coordinators to ensure member transitions of care include local resources and input as needed. Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems. Reinforces clinical philosophy, programs, policies and procedures. Communicates strategic plan and specific tactics to meet plan. Ensures implementation of tactics to meet strategic direction for cost and quality outcomes. Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results. Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes. Accountable for meeting the financial, operational and quality objectives of the unit. May be accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures if there is not supervisor position. Works closely with functional area managers to ensure consistency in clinical interventions supporting our plan sponsors. Develop, initiate, monitor and communicate performance expectations. May act as a single point of contact for the customer and the Account Team which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers. Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills. Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams. Consistently demonstrates the ability to serve as a model change agent and lead change efforts. Accountable for maintaining compliance with policies and procedures and implements them at the employee level. Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.Required Qualifications An Ohio licensed Clinical practitioner with current, unrestricted licensure commensurate with educational field (LISW, LPCC/PCC, IMFT, or RN with behavioral health experience). 2+ years of previous managerial or supervisory experience. 5+ years of clinical experience 3+ year(s) of experience with personal computers, keyboard navigation, and MS Office Suite applications. 2+ years of experience managing or coordinating 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 their family/caregivers. 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. Willing and able to travel as needed, anticipate mostly in-state. Must have reliable transportation, valid/active drivers license, and proof of vehicle insurance. Willing and able to work beyond core business hours of Monday -Friday, 8am-5pm, is required.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Managed care experienceEducation Master's degree required in a Behavioral Health field with LISW, LPCC, or IMFT If Registered Nurse, minimum of Bachelor's degree is required.Business OverviewAt 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.
Created: 2024-09-07