Manager, UM Clinical Health Services - Aetna OhioRISE

CVS Health

7d • Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The OhioRISE (Resilience through Integrated Systems and Excellence) program is a specialized Medicaid managed care initiative focused on providing and coordinating behavioral health services for eligible children and youth. The Manager, UM Clinical Health Services serves as a key Behavioral Health leader within the Aetna Medicaid plan, overseeing utilization management activities. This role is responsible for the oversight, development, and performance of clinical teams, including driving high-quality processes, ensuring compliance, and fostering strong team performance. This is a full-time, fully remote position. Eligible candidates must reside within the state of Ohio. Fundamental Components 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. Will be accountable for meeting the financial, operational and quality objectives of the unit. Will be accountable for the day-to-day management of team(s) for appropriate implementation and adherence with established practices, policies and procedures. Works closely with other 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.

Requirements

• Ohio resident
• Licensed independent Behavioral Health clinician (LISW, LPCC, LMFT) or a Registered Nurse (RN) with unrestricted Ohio state license with psychiatric specialty, certification, or experience
• 5+ years of clinical practice experience in behavioral healthcare
• 2+ years utilization management experience is required (preferably in a managed care setting)
• 2+ years of demonstrated healthcare leadership experience required (preferably in a managed care setting)
• 2+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications
• 1+ year(s) of experience with electronic medical records
• Must possess reliable transportation and be willing and able to travel in-state up to 10% of the time. Mileage is reimbursed per our company expense reimbursement policy.
• Ability to work core business hours, Monday-Friday, 7:30am-5pm EST, with flexibility to work on call occasional weekend hours is required.
• Must have high speed internet access

Nice To Haves

• Managed care/utilization management experience strongly preferred
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
• Medicaid experience
• If RN, BSN degree preferred
• If Behavioral Health: Master’s degree in a field leading to independent Behavioral Health clinical licensure (LCSW, LPCC, LMFT
• If Registered Nurse: Master's degree or equivalent experience in clinical area of expertise (e.g. bachelor's degree plus 7 years' experience; associate's degree or RN diploma plus 9 years' experience).

Responsibilities

• 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.
• Will be accountable for meeting the financial, operational and quality objectives of the unit.
• Will be accountable for the day-to-day management of team(s) for appropriate implementation and adherence with established practices, policies and procedures.
• Works closely with other 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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager