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.
This position assesses overall network composition and potential provider partners in order to identify and service partnerships that will advance and differentiate the OhioRISE Network. This executes, services and may negotiate contracts with local market providers in accordance with company and program standards to enhance provider networks and exceed accessibility, quality, and financial goals and cost initiatives. Must reside in Ohio.

Fundamental Components:

• Optimizes interactions with assigned providers and

internal business partners to establish and maintain
productive, professional relationships and partners on
the development of business strategy and programs to
support the operational plans.

• Collaborates cross-functionally to ensure resolution of

escalated issues or projects for assigned provider
systems and monitors performance and adherence to
scorecards and payout schedules based on established
quality, growth, and clinical measures.

• 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.

• Assists with the design, development, management, and

or implementation of strategic network configurations
and integration activities.

• Serves as SME for less experienced team members and

internal partners.

Pay Range
The typical pay range for this role is:
Minimum: 60,300
Maximum: 130,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

• At least 2 years of behavioral health market and

strong experience building and maintaining relationships
with Behavioral Health providers.

• 5+ 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.

• Ability to travel in-state as needed.
• Must have reliable transportation.
• 2-3 years of experience with MS Office Suite

applications.

Preferred Qualifications

• In depth knowledge of Ohio managed care market,

Medicaid preferred.

• Strong communication, critical thinking, problem

resolution and interpersonal skills.

• Understands the regulatory environment and ensures

contractual compliance with state requirements.

Education

• Bachelor’s degree or equivalent combination of education

and experience.

Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. 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.