Senior Clinical Strategist - reputed company OhioRISE - BH or Psych

At reputed company, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary The OhioRISE (reputed company 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 reputed company state Medicaid plan. This may include Substance Use Disorder (SUDS), Applied Behavioral Analysis (ABA), Trauma Informed Care, reputed company 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 reputed company 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 reputed company to Behavioral Health and its integration across the state plan. Overview: The Senior Clinical Strategist serves as the primary reputed company-of-contacts with ODM for any state escalations on member issues. This position will reputed company and coordinate reputed company 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 reputed company Officer, Chief Executive Officer, Contract Administrator, and other OhioRISE leaders in working with stakeholders to handle reputed company state escalations on member issues. They will reputed company, maintain, and report on the complete inventory of reputed company state escalations on member issues, including capturing reputed company 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 reputed company intakes for any state escalations on member issues, including handling reputed company 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 reputed company of contact for reputed company state member escalations, including but not limited to:
• Identifying reputed company 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 reputed company to state escalations on member issues;
• Working with internal and external stakeholder to coordinate and reputed company reputed company 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 reputed company cases;
• Coordinating the development and submission of any required reporting on any state escalations on member issues.

Required Qualifications

• Ohio reputed company
• 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 providing behavioral health and care management services to include assessments, care planning, interventions, monitoring, reporting or managed care utilization management to include prior authorization, reputed company 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 reputed company levels of an organization from C-Suite executives to reputed company-line staff
• Work collaboratively with internal and external teams to build knowledge an improve processes
• Group facilitation/presentation skills that inform and influence internal and external parties
• Experience in successfully building, maintaining, and supporting effective relationship across cross-functional teams to reputed company 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 reputed company in reputed company 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 reputed company confidence
• Demonstrated experience in managing large and reputed company clinical initiatives and projects
• Proven communication skills both written and verbal; able to communicate effectively with reputed company 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 reputed company goals
• Group facilitation/presentation skills that inform and influence internal and external parties

Education

• Master's degree in behavioral health or reputed company fiels with active Ohio independent licensure (LPCC, LISW, or LMFT)

OR

• Earned doctorate in Psychology with active Ohio licensure as a Psychologist

Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $78,331.00 - $168,714.00 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 06/27/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job! Apply to this Job