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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.
Position Summary
The Senior Clinical Strategist is a Behavioral Health leader for the Aetna state Medicaid plan. This may include Substance Use Disorder (SUDS), Applied Behavioral Analysis (ABA), Trauma Informed Care, Person Centered services and more as dictated by the business needs of the plan. The incumbent functions as the Behavioral Health Subject Matter Expert (SME) for the plan and works across various departments including Care Management, Utilization Management, Quality Management, and Medical Management on issues related to Behavioral Health. Further, the incumbent functions as the Behavioral Health SME for departments such as Member Services, Provider Relations, Network, and provider Credentialing. Position works closely with the state Executive leadership team related to Behavioral Health and its integration across the state plan.
Overview: The Senior Clinical Strategist serves as the primary point-of-contacts with ODM for any state escalations on member issues. This position will interface and coordinate all activities with various OhioRISE departments including Utilization management, clinical services, Provider Relations, Member Services, Operations and Network. This position supports the Behavioral Health Clinical Director, Chief Clinical Oversight Officer, Chief Executive Officer, Contract Administrator, and other OhioRISE leaders in working with stakeholders to handle all state escalations on member issues. They will develop, maintain, and report on the complete inventory of all state escalations on member issues, including capturing all status updates from internal and external sources. The incumbent will work to ensure timely resolution of member escalation issues and prioritize meeting the clinical needs of our members.
This is a fully remote position. Eligible candidates must live and be licensed in Ohio.
Core duties:
Handle all intakes for any state escalations on member issues, including handling all Just Cause cases;
Field and coordinate OhioRISE and CME responses for state member escalations;
Coordinate, prepare for, and facilitate any meetings with internal and external stakeholders;
Serve as the OhioRISE Plan's point of contact for all state member escalations, including but not limited to:
Identifying Aetna and CME contacts to work on any member escalations
Coordinating the development and submission of any responses for the OhioRISE to ODM;
Coordinating OhioRISE Plan's representation and attendance for any meetings related to state escalations on member issues;
Working with internal and external stakeholder to coordinate and oversee all member transition activities for any members escalated by the state escalations to ensure the safe, timely, and orderly transition of members and their care;
Creative problem-solving with community partners to meet the needs of at-risk youth;
Provides clinical expertise in the interdisciplinary team, with requisite range and depth of subject matter expertise to meet the needs of the covered population.
Assisting community stakeholders, providers, CMEs, and OhioRISE Care management staff with complex cases;
Coordinating the development and submission of any required reporting on any state escalations on member issues.
Required Qualifications
Ohio resident
Active and unencumbered independent Ohio Behavioral Health License in one of the following - LPCC, LISW, LMFT, or Psychologist
Minimum 5 years demonstrated experience in Behavioral Health service delivery or administration
Demonstrated experience in providing behavioral health and care mnagement services to include assessments, care planning, interventions, monitoring, reporting or managed care utilization management to include prior authorization, concurrent review
Knowledge and experience with public youth serving systems including Child Welfare, Developmental Disabilities, Mental Health and Recovery, Juvenile Justice.
Knowledge of, and experience accessing, service, placements, and funding.
Proven communication skills both written and verbal and able to communicate effectively with all levels of an organization from C-Suite executives to front-line staff
Work collaboratively with internal and external teams to build knowledge an improve processes
Group facilitation/presentation skills that inform and influence internal and external parties
Experience in successfully building, maintaining, and supporting effective relationship across cross-functional teams to achieve goals
Deep knowledge of Medicaid services in Ohio to multisystem involved youth
Understanding and experience working with Ohio Department of Medicaid
Willing and able to travel in-state up to 10% of the time with a personal vehicle. Mileage is reimbursed per our company expense reimbursement policy.
Preferred Qualifications
Ability to manage multiple timelines and produce evidence of driving toward success with regular updates on progress in all areas of clinical project or program management
Participate in strategic projects and process improvements based on lessons learned
Profound understanding of clinical workflows and best practices
Ability to effectively manage client expectations and inspire confidence
Demonstrated experience in managing large and complex clinical initiatives and projects
Proven communication skills both written and verbal; able to communicate effectively with all levels of the enterprise
Work collaboratively with internal and external teams to build knowledge and improve processes; experience in successfully building, maintaining, and supporting effective relationships across cross-functional teams to achieve goals
Group facilitation/presentation skills that inform and influence internal and external parties
Education
Master’s degree w/ active Ohio independent licensure (LPCC, LISW, or LMFT)
Earned doctorate in Psychology and Ohio licensure as a Psychologist
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$78,331.00 - $168,714.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
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.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 04/02/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.