Care Plan Reviewer- OhioRISE at CVS Health

Ohio, Illinois, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Medicaid, Behavioral HealthIndustries

Requirements

Unencumbered Behavioral Health clinical license in Ohio (LMFT, LSW, LPC)
2+ years of experience in children's mental health, child welfare, developmental disabilities, juvenile justice, or a human services or behavioral health care field

Responsibilities

Be clinically and culturally competent/responsive with training and experience necessary to provide clinical consultation for members' complex needs across child-serving systems
Assess Member’s Child and Family-Centered Care Plans and Crisis and Safety Plan: Through the use of clinical tools and information/data review, review assessments of member's needs and determines approach to meeting needs by evaluating comprehensiveness of member’s Child and Family-Centered Care Plans; applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues; using advanced clinical skills, review crisis and safety plans for members experiencing a behavioral health need to support appropriate individualized trauma-informed interventions and de-escalation strategies
Enhance Medical Appropriateness and Quality of Care: Application and/or interpretation of applicable criteria and clinical guidelines, policies, procedures, and regulatory standards while completing reviews and prior approvals to assess member’s needs to ensure timely 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 achieve 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 motivational interviewing skills to provide coaching to care coordination staff and supervisors to support the child and family-centered care planning process consistent with System of Care Principles and High-Fidelity Wraparound practice; provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices; analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs

Skills

Clinical Case Management

Behavioral Health

Care Plan Review

Crisis and Safety Planning

Child and Family-Centered Care

Psychosocial Services

Clinical Judgment

Critical Thinking

Medicaid Managed Care

Cultural Competency

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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