The Care Plan Reviewer (Clinical Case Manager BH) utilizes advanced clinical 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.Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems.Assessment of Members: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 complex clinical indicators which impact care planning and resolution of member issues. Using advanced clinical skills, performs crisis intervention 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.Enhancement of Medical Appropriateness and Quality of Care:Application and/or interpretation 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 achieve optimal outcomes.Required QualificationsActive and unrestricted Behavioral Health clinical license in the state Ohio is required (ex: LMFT, LIMFT, LSW, LISW LPC,LPCC).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.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.2+ years of 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.Willing and able to travel up to 10% for occasional regional trainings/meetings in the state of OH as need basis. (Includes travel to Columbus, OH office for quarterly yearly meetings/trainings is also expected.).1+ year(s) of experience with personal computers, keyboard, multi-systems navigation, and MS Office Suite applications.Reliable transportation required; Mileage is reimbursed per our company expense reimbursement policy.Verifyable High School Diploma or GED Required.Education Active and unrestricted BH clinical license in Ohio. (ex. LMFT, LIMFT, LSW, LISW, LPC, LPCC)Note :M-F 8-5pm ESTFully remote (never coming onsite)Travel may be needed depending on where candidate is located. Up to 50 miles from home address.VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
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