CVS Health Hiring For Director, Cm Clinical Health Services (ohrise) at Columbus, OH, United States Full Time

Job Description

Business Overview:
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.

Position Summary:
This is a fulltime teleworker opportunity in Ohio. The Director of Clinical Health Services provides oversight for the implementation and on-going execution of the strategic and operational business plan for the business segment’s clinical operations, inbound/outbound call queue, implementation, and/or plan sponsor operations. Coordinate business segment policies and procedures in support of financial, operational and service requirements. Implement care coordination services provided to plan populations in order to meet specific regulatory requirements and provide holistic bio-psycho social care to members in a cost-effective manner. Must reside in Ohio. Travel is anticipated, mostly in-state.

Fundamental Components:

• Must be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems.
• Develop and manage clinical operations focused on improving clinical and financial outcomes, member engagement, and satisfaction.
• Develop strategies to mitigate high cost/high need utilization of services.
• Serve as liaison with regulatory and accrediting agencies and other health business units.
• Formulate and implement strategy for achieving applicable

department/unit metrics and provide operational direction.

• Serve as technical, professional and business resource (may cross multiple business functions).
• Develop and participate in presentations and consultations to existing internal and external stakeholders.
• Direct/provide enhancements to business processes, policies and infrastructure to improve operational efficiency (may cross multiple business functions).
• Participate in internal and external health industry development efforts.
• Develop, implement, and evaluate policies and procedures, which meet business needs (may cross multiple business functions).
• Collaborate and partner with other business areas across/within regions or segments and within other centralized corporate areas to ensure all workflow processes and inter-dependencies are identified and addressed on an on-going basis.
• Promote a clear vision aligned with company values and direction; set specific challenging and achievable objectives and action plans; motivate others to balance customer needs and business success; challenge self and others to look to the future to create quality products, services, and solutions.

Required Qualifications

• .Active and unrestricted Ohio Licensure in applicable functional area (LISW, IMFT, LPCC, OR RN with behavioral health experience).
• .5+ years of experience in the provision and supervision of treatment services for mental illness and substance use disorders for children and adolescents.
• 8+ years of clinical leadership experience.
• Experience with children and adolescents with complex behavioral health needs, multi-system experience, and understanding of managed care and other child-serving systems, including child welfare, juvenile justice, and developmental disabilities.
• Demonstrated experience with synthesizing program performance and clinical outcomes.
• Demonstrated proficiency with personal computers, keyboard navigation, and MS Office Suite applications.
• Ability to travel 10-25% of the time; travel with personal vehicle, must have reliable transportation, valid/active drivers license, and proof of vehicle insurance.
• Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm, is required

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

• If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

• If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

• Ability to communicate in a highly effective manner with internal and external constituents in both written and oral format.
• Ability to evaluate and interpret data for the purpose of developing new programs and processes to meet business demands.
• Ability to synthesize program performance and clinical outcomes.
• Certified Case Manager (CCM) is preferred.

Education

• If RN, MSN degree is preferred.
• If BH Clinician, Master’s degree in in social work, counseling, or marriage and family therapy is required.

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.