The Care Plan Reviewer (Clinical Case Manager BH) utilizes advanced clinical judgment and critical
thinking skills to supports appropriate member behavioral healthcare through review of assessment
and care planning documentation and consultation with care coordinators to support psychosocial
wraparound services to promote effective utilization of available resources and optimal, cost-effective
outcomes.
As 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.
Responsibilities include:
· Be clinically and culturally competent/responsive with training and experience necessary to
provide clinical consultation for members complex need across child-serving systems.
· Assessment of Member’s Child and Family-Centered Care Plans and Crisis and Safety Plan:
o 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.
o 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.
o 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.
· Enhancement of Medical Appropriateness and Quality of Care:
o 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.
o 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.
o Identifies and escalates quality of care issues through established channels.
o Ability to speak to medical and behavioral health professionals to influence appropriate
member care.
o 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.
o Provides coaching, information and support to empower the member to make ongoing
independent medical and/or healthy lifestyle choices.
o Analyzes all utilization, self-report and clinical data available to consolidate information
and begin to identify comprehensive member needs.
Required Qualifications
· Unencumbered Behavioral Health clinical license in Ohio is required (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, providing community-
based services to children and youth, 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.
· 1+ year(s) of experience with personal computers, keyboard, multi-systems navigation, and
MS Office Suite applications.
· Willing and able to travel in-state up to 10% of the time with a personal vehicle.
Preferred Qualifications
· LPCC, IMFT, LISW licenses are preferred.
· 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.
· Managed care/utilization review experience.
· Case management and discharge planning experience
Education
· Minimum of a Master's degree in Counseling, Social Work, or Marriage and Family Therapy is required
