Job Abstract

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

Mission of the position:  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 including members in need of Psychiatric Residential Treatment Facility (PRTF). This position will interface and coordinate all activities with various OhioRISE departments including Utilization management, clinical services, Provider Relations, Member Services, Operations and Network related to PRTF.  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. 

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 as needed regarding PRTF services in Ohio;

• 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;

• 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

• Requires a minimum of 4 years demonstrated experience in Behavioral Health service delivery or administration

• Demonstrated experience in providing behavioral health and Care Management 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 ODM

• One of the following is required:

  • Master’s degree w/ active Ohio independent licensure (LPCC, LISW, or LMFT)

  • Earned doctorate in Psychology and Ohio licensure as a Psychologist

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

Pay Range

The typical pay range for this role is:

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits