Job Title

Job DescriptionAs part of the bold vision to deliver the "Next Generation" of managed care in Ohio Medicaid, Ohio RISE will help children and their families who are experiencing barriers achieve positive health outcomes and high quality of life indicators 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.This is a full-time teleworker position in Ohio with in-state day travel anticipated, 10-25% of the time. The Behavioral Health (BH) Clinical Director for the OhioRISE Plan provides oversight for the daily operational activities of BH services, including mental health and substance abuse, across the full spectrum of care and ensures member access to these services. Coordinates business segment BH policies and procedures in support of financial, operational and service requirements. Implements BH services provided to OhioRISE members in order to meet specific regulatory requirements and provide holistic bio-psychosocial care to members in a cost-effective manner. Qualified candidates must reside in Ohio. Fundamental Components: Serve as a key clinical lead in developing and implementing evidenced-based clinical policies and practices at both the OhioRISE Plan and the clinical practice levels. Promote preventative BH strategies. Participate in management and program improvement activities with other key staff for enhanced integration with primary care and coordination of BH services and achievement of outcomes. Identify and coordinate specific member assistance for BH service needs. Work with clinical leadership to ensuring whole person care by fully integrating physical and behavioral health throughout the care continuum and actively managing transitions of care. Engage in oversight and quality improvement activities associated with BH and case management activities Providing guidance to BH network development recruitment, and value-based contracting, including CMEs in conjunction with OhioRISE Plan's provider relations, COE(s), and ODM Serve as the BH clinical liaison to members, providers and ODM. Promotes a clear vision aligned with company values and direction; set specific challenging and achievable objectives and action plans; motivate others to balance customer needs and business success; challenge self and others to look to the future to create quality products, services, and solutions. Responsible for design, implementation, and monitoring of innovative behavioral health initiatives and program including monitoring of ROI Incumbent will drive excellence in collaboration between various ABH of Ohio functional departments to include UM, QM, and CM Provide meaningful, high quality trainings on behavioral health topics, as needed, to various departments including Provider Relations, Member Services, UM, and CM to ensure continuity and excellence in management of behavioral health servicesSpecific to the OhioRISE contract, responsibilities include but are not limited to:a. Providing daily operational activities of BH services across the full spectrum of care to members, inclusive of mental health and substance abuse services;b. Ensuring access to behavioral health services;c. Serve as a key clinical lead in developing and implementing evidence-based clinical policies and practices at both the OhioRISE Plan and the clinical practice levels. This will necessarily require the integration of relevant pharmacy and social data to inform clinical policies and practices; d. Promoting preventive BH strategies;e. Identifying and coordinating assistance for member needs specific to BH;f. Participating in management and program improvement activities with other key staff for enhanced integration with primary care and coordination of BH services and achievement of outcomes; andg. Working with MCO clinical leadership as needed for integration of all health care needs and services for OhioRISE Plan's members. 3. Other duties and responsibilities of the BH Clinical Director staff must include:a. Engaging in oversight and quality improvement activities associated with case management activities;b. Providing guidance to BH network development recruitment, and value-based contracting, including CMEs in conjunction with OhioRISE Plan's provider relations, COE(s), and ODM; c. Assisting in the review of utilization data to identify variances in patterns, and providing feedback and education to OhioRISE Plan's staff and providers as appropriate;d. Representing the OhioRISE Plan as the BH clinical liaison to members, providers, and ODM; ande. Ensuring whole person care by fully integrating physical and behavioral health throughout the care continuum and actively managing transitions of careRequired QualificationsThe Behavioral Health (BH) Clinical Director must possess an independent, current, and unrestricted Ohio license to provide behavioral health services in the state of Ohio (RN) with Advance Practice Registered Nurse [APRN] licensure, psychologist, licensed independent social worker [LISW], professional clinical counselor [LPCC], independent marriage and family therapist [IMFT].- Minimum of five years of experience in the provision and supervision of treatment service for mental illness and substance use disorders for children and adolescents. - Must have specialty experience with children and adolescents with complex behavioral health needs, multi-system experience, and understanding of managed care. - Demonstrated knowledge and understanding of Ohio's overall behavioral health system that includes mental health, alcohol and drug addiction; developmental disabilities services; child welfare system; juvenile justice system; as well as Family and Children First Councils. - 3+ years previous management or clinical leadership experience.- Ability to communicate in a highly effective manner with internal and external constituents in written, oral and presentation formats.- Ability to evaluate and interpret data for the purpose of developing new programs and processes to meet business demands.- Ability to synthesize program performance and clinical outcomes.- Reside in Ohio-Ability to travel mostly in-state with personal vehicle; must have reliable transportation, valid/active driver's license, and proof of vehicle insurance.- Demonstrated proficiency with personal computer, keyboard navigation skill, and MS Office Suite Applications.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications- Managed Care Experience- Demonstrated experience with the Ohio Youth Behavioral Health and Juvenile Justice systemsEducationMaster's degree in one of the following areas of study: nursing, social work, psychology, clinical counseling, or marriage and family therapy from a CACREP accredited graduate programBusiness OverviewBring your heart to CVS HealthEvery 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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.