A Brief Overview:As part of the bold vision to deliver the "Next Generation" of managed care in Ohio Medicaid, OhioRISE 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- Ability to communicate effectively and professionally with Providers, Members, Staff, External entities, and Leaderships both in oral and written formats.
- Serve as a model to team member regarding practice standards, quality of interventions, problem resolution and critical thinking
- Evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes to including best practice standards and innovations to better address member needs across the health plan
- Oversight of care coordination staff to ensure compliance of ODM, state regulations, documentation, member, and stakeholder needs
- Assist in the support, development and oversight of all communicate and documentation standards required for Care Coordination department
- Ability to multi-task on various projects, utilizing multiple systems and ensure priority deadlines are met.
- Possess ability to work independently and can take initiative on identifying interim/permanent solutions to daily or large-scale problems.
- Support and establish a positive work environment that promotes teamwork, acknowledges team contributions, solicits input, and offers personal assistance when needed.
- Ability to maintain flexibility and adjust to changing needs within health plan needs that may require ongoing Re-prioritization of tasks
- May develop/assist in creation and/or review new training content for immediate team and/or collaborate/deliver inter-departmental training sessions as needed
- Problem solving and decision making skills
- Works closely with functional area managers to ensure consistency in clinical interventions supporting our members. Accountable for meeting the financial, operational, and quality objectives of the department.
- Oversees the implementation of healthcare management services for assigned functional area. Implements clinical policies & procedures in accordance with applicable regulatory and accreditation standards (e.g. NCQA, state and federal standards and mandates as applicable, etc).
- Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care.
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
- Develop, initiate, monitor, communicate performance expectations, and provide performance management, as needed.
- Ensures the team's understanding and use of information system capability and functionality.
- Participate in the recruitment and hiring process for staff using clearly defined requirements in terms of education, experience, technical, and performance skills.
- Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams.
- Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance.
- Consistently demonstrates the ability to serve as a model change agent and lead change efforts. Create a positive work environment by acknowledging team contributions, soliciting input, offering assistance, supporting positive team culture with Heart At Work Behaviors, and monitoring of individual and team performance.
Required Qualifications- Must reside in the state of Ohio
- Minimum 3-5 years post master's degree clinical experience required for Behavioral Health License and 5 years post bachelor's clinical experience for RN License at Master level.
- One of the following active and unrestricted Ohio licenses is required: RN Master level, LISW, LISW-S, LPCC, LPCC-S, LMFT
- Willing and able to participate in up to 10% of travel for any as needed health plan meetings
- Previous leadership experience including the oversight of staff
Preferred Qualifications- Managed Medicare/Medicaid experience
EducationMust have a LISW, LISW-S, LPCC, LPCC-S, RN Master level
Anticipated Weekly Hours40
Time TypeFull time
Pay RangeThe typical pay range for this role is:
$80,340.00 - $173,040.00
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.
Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 07/31/2026
