Manager, CME Care Coordination Support Team (OHRISE)
Location: New Albany, Ohio
Internal Number: 1939263BR
Job Description Business Overview As part of the bold vision to deliver the âœNext Generationâ of managed care in Ohio Medicaid, Ohio RISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.
Position Summary: This is a full time telework opportunity in Ohio. The Manager, of the CME Care Coordination Support Team, is responsible for the oversight and management of clinical team processes; and the organization and development of high performing teams. This position leads the Care Management Entities (CME) Care Coordination Support team. The support team works closely with regional CMEs and travels to CME offices and member locations within the region. This team supports the coordination of member care and services and develops policies and procedures that improve care coordination while meeting regulatory and contract requirements. This position also collaborates with the Ohio Department of Medicaid (ODM) staff, physical health Managed Care Organizations (MCOs), community partners, and other child-serving external organizations, and care coordination team members and/or matrixed staff as required in support of the OhioRISE program. This position requires some in-state travel.
Fundamental Components: â¢ Be clinically and culturally competent/responsive with training and experience necessary to manage complex cases in the community across child-serving systems. â¢ Reinforces health services philosophy, programs, policies and procedures. â¢ Develops and reinforces interventions to ensure effective care coordination for OhioRISE members receiving services from CMEs. â¢ Ensures implementation of tactics to meet strategic direction. â¢ Identifies opportunities to implement best practice approaches and introduce innovations to improve outcomes. â¢ Accountable for meeting the operational and quality objectives of the unit. â¢ Accountable for the day-to-day management of the team for appropriate implementation and adherence with established practices, policies and procedures. â¢ Along with the CME Relationship management team, participate in stakeholder meetings, implementation activities, and oversight of CME care coordination activities. â¢ Works closely with regional care coordination managers to ensure consistency in clinical interventions. â¢ Develops, initiates, monitors and communicates performance expectations. â¢ Participates in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical and performance skills. â¢ Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams. â¢ Consistently demonstrates the ability to serve as a model change agent and lead change efforts. â¢ Accountable for maintaining compliance with policies and procedures and implements them at the employee level. â¢ Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes. â¢ Communicates with other departments to maximize stakeholder experiences. â¢ Supports audit efforts to ensure that CMEs are compliant with state contractual requirements.
Required Qualifications â¢ Active unrestricted Ohio Licensure in applicable functional area. (e.g., LISW, LPCC, IMFT, or RN) is required. â¢ Willing and able to work beyond core business hours of Monday-Friday, 8am-5pm, is required. â¢ 5+ years in clinical area of expertise. â¢ 1+ year(s) supervisory/managerial experience â¢ 2+ years of experience in children's mental health, child welfare, developmental disabilities, juvenile justice, or a related public sector human services or behavioral healthcare field, providing community-based services to children and youth, and their family/caregivers â¢ Experience in one or more of the following areas of expertise: family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development â¢ 1+ year(s) of experience with personal computer, keyboard navigation, and MS Office Suite applications. â¢ Willing and able to travel in-state, up to 10% of the time with a personal vehicle; must possess reliable transportation, valid/active driverâ™s license, and proof of vehicle insurance.
COVID Requirements CVS Health requires its Colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, or religious belief that prevents them from being vaccinated.
If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.
Preferred Qualifications â¢ Managed Care experience. â¢ Care Management experience. â¢ If RN, BSN preferred.
Education â¢ Master's degree in behavioral health field required with behavioral health licensure OR if RN, a bachelor's degree (BSN) is preferred.
Business Overview At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all.
At CVS Health, we work every day to help people on their path to better health. Never has it been more important for us to deliver on our purpose to our valued customers, patients, members, and employees. With a presence in communities across the country, CVS Health colleagues are and will continue to be a critical piece of the country’s health care solution. The health and safety of our employees, patients, customers, and members is our top priority as we face the impact of COVID-19 together. If you would like to learn about the actions we are taking as a company as we learn more about COVID-19 and its spread, we encourage you to visit our COVID-19 resource center at https://cvshealth.com/covid-19
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to... attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. Please note that we only accept applications for employment via this site.
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