Position Summary
This is a full-time remote teleworker position in Ohio. Travel is required up to 10%% of the time to surrounding regions in Ohio, corporate office in New Albany, Ohio, or support to areas in Ohio to assist with member, stakeholder, or direct report needs. Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna OhioRISE. Health Services strategies, policies, and programs which are comprised of quality management and clinical coverage to support current and emerging policies. The Manager, Clinical Health Services is responsible for oversight and management of clinical team processes including the organization and development of high performing teams. 

The Manager, Clinical Health Services is responsible for the oversight and management of clinical team processes, and the organization and development of high performing teams. Core business hours are Monday-Friday, 8AM-5PM

Position Responsibilities

• Reinforces clinical philosophy, programs, policies, and procedures.  

• Communicates strategic plan and specific tactics to meet plan.  

• Ensures implementation of tactics to meet strategic direction for cost and quality outcomes.  

• Creates direction and communicates a business case for change by focusing on and addressing key priorities to achieve business results.  

• Identifies opportunities to implement best practice approaches and introduce innovations to better improve outcomes.  

• Accountable for meeting the financial, operational, and quality objectives of the unit.  

• Accountable for the day-to-day management of assigned team for appropriate implementation and adherence with established practices, policies, and procedures.  

• Works closely with functional area managers to ensure consistency in clinical interventions supporting our plan sponsors.  

• Develop, initiate, monitor and communicate performance expectations.  

• May act as a single point of contact for the customer and the Account Team which includes participation in customer meetings, implementation and oversight of customer cultural requirements, and support implementation of new customers.  

• 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.  

• Consistently demonstrates the ability to serve as a model change agent and lead change efforts.  

• Accountable for maintaining compliance with policies and procedures and implements them at the employee level.  

• Ability to evaluate and interpret data, identify areas of improvement, and focuses on interventions to improve outcomes. 

• Ability to proactive address any performance management needs for direct reports

• Ability to met or exceed KPI and business metrics for the direct team that is being managed

• Working with internal, external, and state regulatory personnel with professionalism and provide prompt remediation processes

• Some travel required per organizational needs as applicable to role and responsibilities not limited to home base office in New Albany, OH. 

Required Qualifications

• Resides in Ohio

• Active Ohio unrestricted state independent licensure in applicable functional area such as RN (BSN/MA), LPCC, LPCC-S, LISW, LISW-S (Master's degree in behavioral health field

• 5+ years’ experience in clinical area of expertise

• 2+ years’ experience leading and managing large teams

• 2+ years’ experience with personal computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (i.e Outlook, Word, Excel, Sharepoint, Teams)

• Must possess reliable transportation and be willing and able to travel in the assigned region up to 10% of the time.

Preferred Qualifications

• • Managed care experience

• • Medicaid experience

• • Familiarity with QuickBase

• Remote work experience

• Experience working with children, adolescent, and young adults

Education
Active Ohio unrestricted state independent licensure in applicable functional area such as RN (BSN/MA), LPCC, LPCC-S, LISW, LISW-S (Master's degree in behavioral health field)

Work from Home Requirements:

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum

download speed of 25 mbs download and 3 mbs upload.

If your computer is not hardwired you must have capabilities to have the same aforementioned download and upload requirements

• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and

HIPAA guidelines, and allowing for uninterrupted work during work hours.

• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.

• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture

(desk or standing desk, as this position would require you to be at your desk for extended periods of time).

If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements:

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to

streamline tasks and improve efficiency.

• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.

• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).

• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.

• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving

internet connection issues, and contacting IT for unresolved technical issues.

• Future Growth: Openness to learning new skills in the future as the workplace environment evolves

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. 

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 .