OhioRISE CME Relationship Manager - Must reside in Ohio

CVS Health

3d

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Summary: Responsible for ongoing client relationship management and satisfaction for assigned initiatives that impact the delivery of services to our OhioRISE members in the internal and external environment. Accountable for transferring knowledge, best practices (external and internal), methodology and tools to internal and external partners and organizations. Participates as a team member, representing the Aetna Better Health OhioRISE plan and ensuring compliance with contractual requirements including the exchange of data to ensure appropriate CME oversight.

Requirements

• Knowledge of medical management processes and managed care.
• Ability to communicate in a highly effective manner with internal and external stakeholders in both written and oral format.
• Experience with moderate scale initiatives with moderate degree of complexity.
• 5+ years’ experience with one or more of the following methodologies: management consulting, project consulting, business process consulting, strategic business planning, relationship management, and provider/network relations.
• Demonstrated relationship management skills at the senior level; capacity to quickly build and maintain credible relationships at varying levels of the organization simultaneously.
• Demonstrated leadership with relevant initiatives: Business process, compliance, enterprise business project management/consulting, and analysis, strategic planning, risk management.
• Demonstrated superior business process, project management and organizational redesign experience.
• Demonstrated experience successfully implementing change in complex organizations.
• Operational experience in a relevant discipline.
• Bachelor's degree or equivalent work experience
• Must reside in Ohio

Nice To Haves

• Master's degree preferred

Responsibilities

• Serves as primary point of contact for the CMEs.
• Brokers relationships with and for the CMEs, using superior oral and written communication skills, to maximize the CME experience and ensure OhioRISE members receive timely, effective, and efficient services and supports to address their complex, multi-system needs and meet their identified goal(s).
• Meets and communicates regularly and consistently with all assigned CMEs to ensure they are fully knowledgeable on the CME’s approach to OhioRISE. Act as the Aetna ‘expert’ on their assigned CMEs.
• Serve as the Aetna expert on the CME’s membership and enrollment profile.
• Based on issues and needs identified by the CME, troubleshoot Aetna systems, and connect CME partners with the necessary and appropriate Aetna resources supports.
• Facilitates and provides education and training to assigned CMEs on OhioRISE processes, procedures, protocols, desktops, and job aids.
• Understands and monitors compliance with the OhioRISE Ohio Administrative Codes, Provider Agreement, CME Contract, and CME Manual. Provides oversight of CME’s contractual obligations.
• Is familiar with Aetna supports, resources and teams, to ensure assigned CMEs have timely access to needed technical assistance, systems, materials, and other OhioRISE resources.
• Collaborates with CMEs, the Ohio Department of Medicaid (ODM) staff, physical health Managed Care Organizations (MCOs), community partners, and other child-serving external organizations, and care coordination team members and/or matrixed staff as required in support of the OhioRISE program.
• Proactively and strategically identifies opportunities for improvement within assigned initiatives and CME relationship management.
• Proactive participation in influencing CME process improvement activities, to build optimal relationships for results and deliverables, effectively managing the relationship throughout engagement.
• Conducts thorough business case and external customer value analysis to determine selection, prioritization positioning and approach for broadest range of potential solutions (e.g., process improvements, technology solutions).
• Participates and supports metrics integration and execution for optimal results.
• Shares joint accountability and ensures at a minimum the meeting of contractual requirements and expectations.
• Communicates compelling and concise results to empower internal/external stakeholders in decision making process regarding opportunities for improvement.
• Participates in initiative planning as required.
• Designs, develops interventions, and facilitates meetings, trainings, presentations, JOC, and other work sessions, as assigned. Develops and delivers all required analysis, reporting and presentation materials.
• Gathers, analyzes, and synthesizes business intelligence to drive achievement of strategic business objectives.
• Builds and utilizes diverse internal and external networks, as appropriate, for data gathering and best practice identification. Leverages internal and external networking to drive optimal initiative results and knowledge/best practice transfer.
• Collaborates with Aetna Better Health, OhioRISE plan staff that support oversight of CME activities.
• Provides timely feedback on the overall CME experience for Aetna Business and Clinical partners. Understands risk and proactively escalates CME issues/trends to OhioRISE. Serves as functional area leads.
• Manages the bi-directional flow of information between assigned CMEs and Aetna.
• Builds collaboration between Aetna and CME front line staff.
• Deep knowledge of the CME Contract and the CME responsibilities in the OhioRISE Provider Agreement.
• Knowledge of the OhioRISE Program, Services, and Benefits.
• Other duties as assigned.

Benefits

• This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level