Manager Clinical Health Services - OhioRISE

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Job Summary

The OhioRISE (Resilience through Integrated Systems and Excellence) plan is a Medicaid managed care program that provides and coordinates behavioral health care for eligible children and youth. The Manager, Clinical Health Services manage and oversees the work of the Clinical Health Services department and direct day-to-day activities of the team. The manager will develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna's OhioRISE program. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. The Manager is responsible for oversight and management of clinical team processes including the organization and development of high performing teams.This is a remote role. Eligible candidate must reside in the state of Ohio.Some travel required per organizational needs as applicable to role and responsibilities not limited to home base office in New Albany, OH.Primary Job Duties and Responsibilities

• Administers an effective Clinical Health Services program through multi-disciplinary teams to improve health care outcomes and client satisfaction.
• Develops actionable insights on opportunities and fosters programs to improve the operational efficiency and cost-effectiveness of Clinical Health Services processes and programs.
• Oversees the Clinical Health Services department's compliance with federal and local requirements and departmental guidelines and procedures.
• Plans, develops, and manages the budget, exercising appropriate fiscal constraints to ensure the most efficient and economic practices for optimal service delivery within established budget.
• Remains abreast on all current laws pertaining to the department and company operations.
• Negotiates written agreements with outside providers and facilities in conjunction with other internal departments.
• Establishes and maintains cooperative and productive professional relationships with health coordinators and case managers at various facilities and community organizations.
• Provides direct supervision to the Clinical Health Services staff, and other staff personnel assigned to the administration.
• Ensures professional cooperation between Clinical Health Services and all other departments and administrations.
• Serves as a model to team member regarding practice standards, quality of interventions, problem resolution and critical thinking
• Evaluates and interpret data, identify areas of improvement, and focus on interventions to improve outcomes to including best practice standards and innovations to better address member needs across the health plan
• Assist in the support, development and oversight of all communicate and documentation standards required for Care Coordination Phone Queue Line, Care Coordination Email and any large scale needs identified by the Health Plan
• Works independently and can takes initiative on identifying interim/permanent solutions to daily or large-scale problems.
• Supports and establish a positive work environment that promotes teamwork, acknowledges team contributions, solicits input, and offers personal assistance when needed.
• Maintains flexibility and adjust to changing needs within health plan needs that may require ongoing Re-prioritization of tasks
• May develop/assist in creation and/or review new training content for immediate team and/or collaborate/deliver inter-departmental training sessions as needed

• Ohio resident
• Active unrestricted Independent Ohio State Licensure in applicable functional area. (e.g., RN, LPPC, LPPC-S, LISW, LISW-S, LMFT)
• 5 years' experience in clinical area of expertise
• 3 years' leadership experience including the oversight of staff, preferably in a managed care organization
• Willing and able to participate in up to 10% of travel for any as needed health plan meetings
• Computer literacy and experience with Microsoft Excel, Word, and other web-based applications.
• Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes.
• Ability to communicate effectively and professionally with Providers, Members, Staff, External entities, and Leaderships both in oral and written formats

• Managed Medicare/Medicaid experience
• Case Management experience

• Master's degree required for BH license
• BSN required for RN license

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.