Apply for Care Coordinator - Associates/Bachelor's

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:Care Coordinator - Associates/Bachelor's
ID:3653
State:Ohio
County:Warren and surrounding counties
Program Type:OhioRISE
Position Type:Full Time
Department:Operations
Resume
* Resume:
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Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
* County of Residence:
Licensure:
Application Information
* Source:
If Referral, provide Name:
If other, explain:
* County of Residence:
Opt-In Confirmation
I authorize recruiters from CareStar, Inc. to send text messages from 8444791158 with requests for additional information in relation to this job application only. Message/data rates apply. Message frequency varies.
Attachments
Cover Letter:
You can type in a Cover Letter or Copy/Paste from an existing document.
Application (V2)
PERSONAL INFORMATION
* Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment):
Yes   No
* Are you at least 18 years or older? (If no, you may be required to provide authorization to work):
Yes   No
* Do you have reliable transportation?
Yes   No
* Have you ever worked for this Company before?:
Yes   No
If Yes, please provide details (Where/When/Job Title):
* Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?:
Yes   No
If no, please explain:

EMPLOYMENT DESIRED
* When would you be available to begin work?:
* Type of employment desired:
Full-Time
Part Time
* Hourly rate/salary earned at last position.:

EDUCATION
Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School Name & Location Did you Graduate? Degree Received Subjects Studied/Major
Yes   No
Yes   No
Yes   No

If you have completed any special courses, seminars and/or training that would help you to perform the position for which you are applying, please describe:

AUTHORIZATION
In consideration for my being considered for employment, I agree to conform to the policies and procedures of CareStar. I understand that by accepting this application, CareStar is in no way obligated to offer me employment and that I am not obligated to accept employment if offered. Furthermore, if CareStar employs me, I understand that my employment will be “at will,” which means that CareStar or I may terminate employment at any time with or without cause.

I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that any falsified statement or omission of fact on this application or during the pre-employment process will result in my application being rejected, or, if I am hired, in my employment being terminated.

I also understand that any offer of employment is conditioned on pre-employment procedures, my performance on written tests that assess skills and content pertinent to the job, Bureau of Criminal Identification and Investigation (BCII) Criminal Background investigation (including fingerprint impressions), and documentation such as proof of residency and eligibility to work in the United States. I will, upon request, sign all necessary consent forms. I also authorize any current or previous employers, schools or educational institutions, individuals, and representatives of the foregoing, to give any information regarding my employment, qualifications, and character. I hereby expressly release said current or previous employers, schools or educational institutions, individuals, and their representatives from any and all liability for any damage that may result from their issuing or disclosing any information or knowledge to CareStar. I have read and understand the contents of this employment application and am fully able and competent to complete it. I understand that I am required to abide by all rules and regulations of the company.

* Signature (type name):
* Date:
Conflict of Interest Questionnaire
Immediate family member is defined as spouse; natural or adoptive parent, child or sibling; step-parent, step-child, step-brother, or step-sister; father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law; grandparent or grandchild; or spouse of a grandparent or a grandchild.
* Are you or is any member of your immediate family or household a current consumer of Ohio Home Care Program (OHCP) services or an applicant for services under the non-OHCP contract?
Yes
No
* If you are responsible for work under any CareStar contract other than the OHCP contract, are your or is any member of your immediate family or household a current client, consumer or applicant for services under the non-OHCP contract?
Yes
No
Not Applicable
* Do you hold an ownership interest in any business?
Yes
No
If yes, name of Company.
What service or product is provided by this company?
* Are you self-employed or employed by any individual, business venture, or  organization other than CareStar?
Yes
No
If yes, name of other employer.
What service or product does the other employer provide?
What hours are you scheduled to work?
For applicants, do you plan to continue other employment if offered employment with CareStar?
Yes
No
Not Applicable
* Do you participate in ANY activities not related to CareStar business during the hours of 8:00 am to 5:00 pm weekdays? (ie:classes, volunteer work, home business activities, etc.)
Yes
No
If yes, what is the activity?
When is the activity scheduled?
How would you anticipate responding to urgent calls during this time?
* Are you a Medicaid Non-Agency Provider (formerly known as an Independent Provider)?
Yes
No
If yes, in what program?
What is your provider number?
* Is any member of your immediate family or household employed by a Home Care Agency, long term care facility, medical equipment supplier or any waiver service provider?
Yes
No
If yes, the immediate family or household member's name.
Their relationship to you
Their employer
Their position
* Does any member of your immediate family or household provide services or supplies as a Medicaid Non-Agency Provider (formerly known as an Independent Provider) or contractor?
Yes
No
If yes, family or household member's name
Their relationship to you
What services do they provide?
What is the service area?
What is their provider number?
Are there any other activities, relationships, investments or other interests that you would like to bring to our attention in an effort to clarify the possibility of a conflict of interest?
FCRA Release V2
Please read and sign the following release form. Your signature authorizes CareStar to perform a review of prior employment and additional consumer and investigative consumer reports as part of the hiring process. CareStar may utilize a third party to complete this review process.
In conjunction with my application for employment (including contract services)  my prospective employer I understand that you intend to hire third parties to obtain Consumer Reports and /or Investigative Consumer Reports (hereinafter called "Reports") about me as defined in the Fair Credit Reporting Act (FCRA).  These "Reports" may include information concerning my credit worthiness, credit standing, credit capacity, character, academic background, credentials, work habits, work performance, work experience, reasons for work termination, general reputation, personal characteristic or mode of living.  You also may seek information concerning my employment history, workers' compensation history, motor vehicle record, education background, civil litigation history and/or criminal record.
* Have you lived in the state the position is located in for 5 or more years?
Yes
No
* If yes, do you have documentation to prove your residency for at least 5 years?
Yes
No
N/A
*
*
NPI and Medicaid Ohio Provider Number_2022-06-20
Please provide all of the following information. The requested information will only be used to apply for an NPI and Ohio Provider Number on your behalf. A signature of acknowledgment and agreement is required for CareStar to apply on your behalf. Social Security information is encrypted to protect highly sensitive data.
* Full Legal Name: Last, First, Middle
* Date of Birth
* Gender
Female
Male
Prefer not to say
* Birth State, County, City, and Zip code
* Social Security Number and Issuing State
* Full Home Address: Street, City, State Zip Code
* Professional License, License Number, Effective Date, and Expiration Date
* Full credential as spelled out specifically on the credential.
* Do you have an existing and in good standing NPI Number?
If yes, What is your NPI number?
* Does CareStar have your approval to apply for an NPI and Ohio Provider number on your behalf?
Yes
No
* Signature of acknowledgment and approval for CareStar to use all provided information to apply for an NPI and Ohio Provider Number on your behalf.
* NPI Security Question: What is your favorite food?
* NPI Security Question: What is your favorite season? (Spring, Summer, Fall, Winter)
* NPI Security Question: What is your favorite sport?
* NPI Security Question: What is your county of residence?
* NPI Security Question: What was the color of your first car?
* Are you CANS certified?
Yes
No
* Copy of IRS W-9 Form with only your signature and date on the bottom of page 1.

https://www.irs.gov/pub/irs-pdf/fw9.pdf
* If you are not a Licensed Social Worker or Registered Nurse, please provide a copy of your highest level diploma. (High School/GED, Associates Degree, Bachelors Degree. etc.)
OhioRISE Prescreening
* Please select any active professional licenses or certifications you currently have.
RN
LPN
STNA
LSW
LISW
MFT
LPC
LPCC
Other
N/A
* If you selected "Other," please indicate your license or certification(s).
* Do you have previous experience as a Case Manager or Care Coordinator?
Yes
No
* If yes, please share your previous job responsibilities and experience.
* How many years of experience do you have working with youth or other individuals with complex behavioral health needs?
No experience
<1 year
1-3 years
4-6 years
7-9 years
10-12 years
12-14 years
15+ years
* Please select the number of years experience you have in Home and Community Based Services.
No experience
<1 year
1-3 years
4-6 years
7-9 years
10-12 years
12-14 years
15+ years
* Select the highest level of education completed.
GED
High School/College Prep
Associates
Undergraduate/Bachelor's
Master's
Doctorate
* Do you have a valid and unrestricted driver's license?
Yes
No
* Do you have experience working from home or in a remote position?
Yes
No
* What do you consider to be an appropriate average percentage of time to travel in a week to complete your job tasks?
25%
35%
45%
55%
65%
75%
85% or more
* Please describe your preferred method of tracking all tasks, responsibilities, and deadlines.
* Share an example of a mistake you have a made in your previous or current position. What did you do to resolve it?
* What do you like least about your current or most recent position?
* What you like most about your current or most recent position?

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
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