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Care Plan Reviewer- OhioRISE at CVS Health - ApplyBlast

Care Plan Reviewer- OhioRISE

CVS Health

4 months ago

3.2 on Glassdoor

Onsite

Full Time

Senior

0 applicants

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About this role

The Care Plan Reviewer (Clinical Case Manager BH) act as a clinical expert within the OhioRISE Medicaid program, utilizing advanced judgment to review assessment and care planning documentation for children with complex behavioral health needs. This role involves consulting with care coordinators to develop trauma-informed intervention strategies, ensuring optimal utilization of resources, and promoting cost-effective outcomes through the application of clinical guidelines and policies.

Responsibilities

Review and evaluate child and family-centered care plans for clinical appropriateness
Apply clinical judgment to incorporate strategies reducing risk factors in complex cases
Utilize advanced clinical skills to review crisis and safety plans for behavioral health members
Analyze utilization and clinical data to identify comprehensive member needs
Consult with medical directors and multidisciplinary teams to resolve care barriers

Skills

Qualifications

Master’s degree in Counseling, Social Work, or Marriage and Family TherapyUnencumbered behavioral health clinical license in Ohio (LMFT, LSW, or LPC)2+ years of experience in children’s mental health or child welfare1+ year of experience with MS Office Suite applicationsExperience in managed care or utilization review

About CVS Health

cvshealth.com

Headquarters

Woonsocket, Rhode Island, United States

Company Size

10001+ employees

Founded

1963

View Profile

CVS Health is America's leading health solutions company, providing integrated services across retail pharmacy (CVS Pharmacy), pharmacy benefits management (CVS Caremark), and health insurance (Aetna). The company offers pharmacy services, health plans, clinical care (including MinuteClinic), and health-and-wellness programs for consumers, employers, and government payers. By combining a large national retail footprint with claims processing, care management, and clinical services, CVS Health aims to coordinate care, lower costs, and improve health outcomes. Businesses and consumers use its solutions for medication management, plan administration, and in-person and virtual care.