Lead Director / Value Based Program Manager

Job DescriptionThis role is remote, but must sit in Ohio.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 role will report to the Executive Director, Network Management. He/she is responsible for coordinating all types of account servicing in order to implement and maintain provider operations according to value-based-contract (VBC) arrangements. This includes setup and on-going maintenance of tech / care management solutions, organizing consultative services and guidance from subject matter experts as needed, as well as back-office functions such as billing, claims and appeals processing. He/she will interact with providers on a regular basis to handle provider requests and concerns while managing routine servicing operations to realize the terms of the VBC and responding to ad-hoc requests / issues raised by providers and Engagement Managers. He/she will coordinate cross-functional groups across ACS and the wider Aetna organization to carry out these servicing activities, many of which are not led by groups within ACS (e.g., Medicity, Informatics). He/she works to ensure that the providers / ACOs are functioning successfully and the VBC arrangement is working to improve quality of care while reducing costs. Manages a cross-functional team of various Aetna, client and external resources to implement and maintain ongoing account services in VBC arrangements with combinations of financial, product, technology, clinical, and operational elements, ranging from infrastructure / network installation for provider solutions, ongoing maintenance of provider solutions (e.g., tech / population health services), payments / appeals processes, report generation, and compliance. Establishes and maintains relationships across ACS and Aetna organizations to use as support for these provider servicing activities. Manages servicing operations on a routine basis, including setting cadence for regular task activities, as well as responding to live direction requests from Engagement Managers. Regularly interfaces with provider to facilitate implementation / maintenance of provider servicing activities and to respond to provider requests / concerns. Ensures adherence to compliance policies and procedures throughout provider account operations, proactively identifying risks and escalating to leadership as appropriate. Responsible for ensuring that provider account services contribute to ACS objective of improving quality of care while reducing costs.Required QualificationsExperience with Value Based Contracting is required. Proven ability to interact with, influence and collaborate with clients at all levels. 5+ years of project management experience in a health plan, health system or provider organization. 8+ years of client management. Experience managing matrixed staff with ability to leverage non-directs to complete tasks. Proven track record managing complex projects and or programs that resulted in cost savings. Good interpersonal and communication skills and ability to form strong client relationships. Knowledge of healthcare and insurance industry. Ability to travel 10 - 25% of the time within the state as needed. Must have reliable transportation, valid/active driver's license, and proof of vehicle insurance.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues 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, religious belief, or other legally recognized reasons that prevents them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications 8+ years of hospital system and/or health insurance industry experience, ACO / managed-care experience preferred.Behavioral Health experience is a big plus.EducationBachelor's degree.Business OverviewBring your heart to CVS HealthEvery 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.

Created: 2024-10-19