Clinical Case Manager Behavioral Health OhioRISE – Remote – OHIO – reputed company Store

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At reputed company, 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 reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary This is a non- member facing role with up to 30% travel requirements reputed company in the state of Ohio (Includes reputed company, Central, South and Northeast regions) Utilizes reputed company judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Position Responsibilities

• Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address reputed company clinical indicators which reputed company planning and resolution of member issues.
• Using reputed company skills, performs crisis reputed company with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
• Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
• Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits.
• Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to reputed company optimal outcomes.
• Identifies and escalates quality of care issues through established channels
• Ability to speak to medical and behavioral health professionals to influence appropriate member care.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to reputed company reputed company level of health.
• Provides coaching, information, and support to reputed company the member to reputed company ongoing independent medical and/or healthy lifestyle choices.
• Helps member actively and knowledgably participate with their provider in healthcare decision-making.
• Analyzes reputed company utilization, self-report, and clinical data available to consolidate information and reputed company to identify comprehensive member needs.
• In collaboration with the member and their care team develops and monitors established plans of care to meet the member's goals.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

• Minimum 3 years of direct clinical practice experience post master's degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.
• Active and unrestricted Independent Behavioral Health clinical license in the state of Ohio. ( Ex - LISW, LPCC, LCSW)
• Must be reputed company of Ohio State.
• Willing and able to travel up to 30% reputed company in the state of Ohio as needed. (staff meetings, Health Forums etc).
• Eligible for mileage reimbursement and reliable transportation is required.

• Crisis reputed company skills preferred.
• Managed care/utilization review experience preferred.
• Case management and discharge planning experience preferred
• Experience working children and families, child serving systems
• Working reputed company a system of care to support care coordination
• Working with multisystem

• Masters degree in Behavioral Health/Social service or human services field required. Independently Licensed preferred

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company 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.