Senior Clinical Strategist (C) - Aetna OhioRISE - BH or Psych

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Position Summary

The OhioRISE (Resilience through Integrated Systems and Excellence) plan is a Medicaid managed care program that provides and coordinates behavioral health care for eligible children and youth. 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 Senior Clinical Strategist 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 Senior Clinical Strategist 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 is an indivisual contributor and serves as the primary point-of-contact with ODM for any state escalations on member issues. The Senior Clinical Strategist 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 Senior Clinical Strategist 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 Responsibilities:

• 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 stakeholders 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 the oversight and/or delivery of behavioral health services, care management, or utilization management, including assessments, care planning, interventions, monitoring, reporting, prior authorization, and 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 and improve processes
• Group facilitation/presentation skills that inform and influence internal and external parties
• Experience in successfully building, maintaining, and supporting effective relationships 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 in behavioral health or related fields with active Ohio independent licensure (LPCC, LISW, or LMFT)

OR

• Earned doctorate in psychology with active Ohio licensure as a psychologist

Anticipated Weekly Hours

Time Type

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. 
 

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Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.