CVS Health Hiring For Manager, Clinical Health Svcs (care Plan Reviewer Team) Ohrise at Cleveland, 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 full time teleworker position in Ohio. The Manager of Clinical Health Services leads the OhioRISE Care Plan Reviewer team and is responsible for oversight and management of clinical team processes including the organization and development of a high performing team. Must reside in Ohio. Travel will be required in-state up to 15% of the time.

Fundamental Components:

• Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems.
• Reinforces clinical philosophy, programs, policies and procedures.
• Communicates strategic plan and specific tactics to meet plan.
• Ensures implementation of tactics to meet strategic direction for cost and quality outcomes.
• Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results.
• Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
• Accountable for meeting the financial, operational and quality objectives of the unit.
• May be accountable for the day-to-day management of teams for appropriate implementation and adherence with established practices, policies and procedures if there is not supervisor position.
• Works closely with functional area managers to ensure consistency in clinical interventions supporting our plan sponsors.
• Develop, initiate, monitor and communicate performance expectations.
• May act as a single point of contact for the customer and the Account Team which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.
• Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills.
• Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams.
• Consistently demonstrates the ability to serve as a model change agent and lead change efforts.
• Accountable for maintaining compliance with policies and procedures and implements them at the employee level.
• Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes.
• Travel to in-state Behavioral Health state meetings with ODM and other community based behavioral health stakeholder meetings on an as needed basis.

Required Qualifications

• Active unrestricted Ohio Licensure in applicable functional area (LISW, IMFT, LPCC, or RN).
• 5+ years in clinical area of expertise.
• 4+ years of MCO experience to include management and oversight of behavioral health related teams and projects.
• 1+ year(s) of supervisory/management experience.
• 2+ years of experience in children’s mental health, child welfare, developmental disabilities, juvenile justice, or a related public sector human services or behavioral health care field, providing community-based services to children and youth, and their family/caregivers.
• Background and 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
• Demonstrated proficiency with personal computers, keyboard and multi-systems navigation, and MS Office Suite applications.
• Ability to travel in-state with personal vehicle. Must have reliable transportation, active/valid drivers license, and proof of vehicle insurance.
• Travel will be required in-state up to 15% of the time.
• Must reside in Ohio

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

• See above

Education

• If RN, BSN degree is preferred.
• If BH Clinician, Master’s degree in behavioral health 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.