Job Description
Business Overview:

As part of the bold vision to deliver the “Next Generation” 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 position acts as the primary resource for assigned, high profile providers or groups (i.e. local, individual providers, small groups/systems) to establish, oversee, and maintain positive relationships by assisting with or responding to complex issues regarding policies and procedures, plan design, contract language, service, claims or compensation issues, and provider education
needs.

Must reside in Ohio.

Fundamental Components:
• Optimizes interactions with assigned providers and
internal business partners to establish and maintain
productive, professional relationships.
• Monitors service capabilities and collaborates cross-
functionally to ensure that the needs of constituents are
met and that escalated issues related to but not limited
to claims payment, contract interpretation, and accuracy
of provider contract or demographic information are
resolved.
• Supports or assists with operational activities that may
include, but are not limited to, database management,
and contract coordination.
• Educates internal and external parties as needed to
ensure compliance with contract policies and
parameters, plan design, compensation process,
technology, performance measurement techniques,
policies, and procedures.
• Meets with key providers periodically to ensure service
levels are meeting expectations.
• Manages the development of agenda, validates
materials, and facilitates external provider meetings.
• May collaborate cross-functionally on the implementation
of large provider systems, to manage
cost drivers, data reports and execute specific cost
initiatives to support business objectives and to identify
trends and enlist assistance in problem resolution.
• May be responsible for provider recruitment, contracting,
or re-contracting activities, or may assist and support
more complex contracting and discussions.
• Drives provider engagement, and may recruit providers,
as needed to ensure attainment of network expansion
and adequacy targets.
• Serves as SME for less experienced team members and
internal partners.

Required Qualifications
• In depth knowledge of behavioral health market and
strong experience building and maintaining relationships
with Behavioral Health providers.
• 3+ years related experience in managed care and
comprehensive level of influencing skills with successful
track record negotiating and/or servicing contracts with
individual or complex provider systems or groups,
preferably in Behavioral Health.
• Strong communication, critical thinking, problem
resolution and interpersonal skills.
• Understands the regulatory environment and ensures
contractual compliance with state requirements.
• Ability to travel in-state as needed. Must have reliable
transportation, valid/active driver’s license, and proof of
vehicle insurance.
• Computer literate; proficiency with MS Office Suite
applications.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions 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, pregnancy, 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 30 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 60 days of your employment. 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, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 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. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
• In depth knowledge of Ohio managed care market,
Medicaid preferred.
• Previous experience with Behavioral Health
• Bachelor’s degree preferred.

Education
• Bachelor’s degree or equivalent combination of education
and experience.

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.