CVS Health Hiring For Manager Health Services, Cme Relationship Team (ohrise) at Akron, 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 fully remote position in Ohio; will require some instate travel. This position provides oversight and management of health services team processes including the organization and development of high performing teams. Develops and designs policies and procedures that improve medical management operations while meeting regulatory and contract requirements. This position leads the Case Management Entity (CME) relationship management team. This team is involved in ongoing relationship management with organizations (CMEs) providing care coordination services to our OhioRISE members. The CME relationship management team collaborates with the CMEs, the Ohio Department of Medicaid (ODM) staff, physical health Managed Care Organizations (MCOs), community partners, and other child-serving external organizations, and care coordination team members and/or matrixed staff as required in support of the OhioRISE program.

Fundamental Components:

• Reinforce health services philosophy, programs, policies and procedures.
• Develop and reinforce interventions to ensure effective CME relationship interactions and support CME operations.
• Ensure implementation of tactics to meet strategic direction.
• Identify opportunities to implement best practice approaches and introduce innovations to better improve outcomes.
• Accountable for meeting the operational and quality objectives of the unit.
• Accountable for the day-to-day management of the team for appropriate implementation and adherence with established practices, policies and procedures.
• May act as a single point of contact for the stakeholders including CMEs, state regulators, and the health plan team which includes participation in stakeholder meetings, implementation activities and oversight of CMEs.
• Assess developmental needs and collaborate with others to identify and implement action plans that support the development of a high performing team.
• Consistently demonstrate the ability to serve as a model change agent and lead change efforts.
• Accountable for maintaining compliance with policies and procedures and implement them at the employee level.
• Ensure team members build and maintain relationships with CMEs to mitigate operational and technical challenges and resolve issues.
• Ability to evaluate and interpret data, identify areas of improvement and focus on interventions to improve outcomes.
• Provide prompt resolution regarding issues that may surface.
• Provide staff training and development.
• Determine policies and procedures that are needed to ensure staff activities meet regulatory requirements.
• Communicate with other departments to maximize stakeholder experiences.
• Support audit efforts to ensure that CMEs are compliant with state contractual requirements.
• Collaborate with licensed staff from other areas that assist with oversight of clinical staff and activities of licensed personnel.

Required Qualifications

• 4+ years of experience in managed care.
• 3+ years of experience in a behavioral healthcare setting.
• 1+ year(s) of management experience.
• Knowledge of the regulations, standards, and policies which relate to medical management.
• Computer literate, proficiency with MS Office Suite applications.
• Ability to travel as required; must possess reliable transportation, valid/active driver’s license, and proof of vehicle insurance.

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 30 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 60 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 30 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

• Bachelor’s degree in health or human services (e.g., Social Work, Psychology, Nursing, Mental Health, Counseling, Behavioral Sciences, Sociology, Gerontology or related field required.
• Master’s degree in health or human services (e.g., Social Work, Psychology, Nursing, Counseling, or Behavioral Health Sciences) is preferred.

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.