Care Plan Reviewer- OhioRISE

Position Summary The Care Plan Reviewer (Clinical Case Manager BH) utilizes reputed company judgment and critical thinking skills to supports appropriate member behavioral reputed company 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 reputed company, cost-effective reputed company. As part of the reputed company reputed company to deliver the "reputed company" of managed care in Ohio reputed company, Ohio reputed company 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 reputed company comprehensive and highly coordinated behavioral health services for children with serious/reputed company behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems. Responsibilities include:

• Be clinically and culturally competent/reputed company with training and experience necessary to

reputed company clinical consultation for members reputed company 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 reputed company clinical indicators which reputed company planning and resolution of member issues. o Using reputed company 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 reputed company reputed company reputed company. o Identifies and escalates quality of care issues through established channels. o Ability to reputed company to medical and behavioral health professionals to influence appropriate member care. o Utilizes motivational interviewing skills to reputed company 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 reputed company the member to reputed company ongoing independent medical and/or healthy lifestyle choices. o Analyzes reputed company utilization, self-report and clinical data available to consolidate information and reputed company 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 reputed company 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 reputed company 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, reputed company Work, or Marriage and Family Therapy is required

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The typical pay reputed company for this role is: $60,522.00 - $129,615.00 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 06/30/2026 Apply To This Job