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.

Must live in NJ. This is a hybrid position and requires 3 days in the office (Tuesday, Wednesday and Thursday) in Princeton, NJ

Position Summary

The Behavioral Health Quality Management Supervisor is responsible for behavioral health quality management and quality improvement for ABHNJ members and providers. The Behavioral Health Quality Management Supervisor shall report to the ABHNJ Quality Management Director and will work in close partnership with the ABHNJ Behavioral Health Medical Director, Behavioral Health Administrator, CMO, Behavioral Health Director of Network Relations and all matrixed growth partners to effectively manage access and quality of behavioral health benefits and care. Successful candidate must live in New Jersey or be willing to relocate

Responsibilities include:

·                Ensuring that systems and procedures exist that assess provider satisfaction. Assessment shall include provider experiences with claims processing, prior authorization, utilization management, and provider complaint resolution

·                Implementation of quality measures of network adequacy

·                Implementation of processes designed to improve access to care for special needs populations including, but not limited to, physically handicapped individuals, individuals with co-occurring conditions, victims of sexual abuse, deaf or blind individuals, pregnant people, and individuals with developmental delays

·                Resolving, tracking, and trending quality of care complaints

·                Ensuring the contractor or its behavioral health subcontractor comply with quality management requirements included in this agreement

·                Ensuring ABHNJ providers can provide services to a culturally and ethnically diverse population with attention to disparities in access or outcomes experienced by traditionally marginalized populations.

·                Monitoring HEDIS and Performance Measures related to Behavioral Health, identifying opportunities for improvement and implementation of interventions as applicable.

Required Qualifications

·       The Supervisor shall have at least three (3) years of experience in quality management and quality improvement. At least five (5) years of experience in managed care network management with demonstrated experience managing a behavioral health provider network.

·       Strong analytical skills and diligence, including executing provider agreements

·       Strong communication skills, both written and verbal

·       Excellent organization and time management skills

·       Experience navigating a matrixed organization.

·       Experience developing and executing project plans and processes.

·       NJ Medicaid regulatory experience

* Certified Professional in Healthcare Quality (CPHQ) by the National Association for Healthcare Quality, or be Certified in Healthcare Quality and Management (HCQM) by the American Board of Quality Assurance and Utilization Review Physicians

Preferred Qualifications
Project management experience preferred.

Education

Bachelor’s degree or High School Equivalent and 4 years of experience or Associate degree and 2 years of experience in health related field.

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