Population Health Specialist

Aetna Medicaid Administrators

7d • Remote

About The Position

At CVS Health, 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 reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary 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. The Population Health Specialist (PHS) leads initiatives to advance health outcomes and reduce disparities for the OhioRISE population. This role applies quality improvement science to lead efforts improving health outcomes for OhioRISE members by identifying disparities and implementing targeted interventions. The PHS analyzes population health data to uncover trends, gaps in care, and opportunities for system-level improvement. Designs and executes quality improvement projects to address identified needs by collaborating with diverse stakeholders, including internal care coordination teams, hospital systems, the Ohio Department of Medicaid, Case Western Center of Excellence, and Care Management Entities. Monitors, evaluates, and reports on the effectiveness of population health interventions to ensure measurable impact. Serves as a quality improvement methodology subject matter expert within the OhioRISE program. This is a full time telework position with occasional travel required (within Ohio) as determined by business need - residing in Ohio is strongly preferred.

Requirements

• 1+ year(s) experience in population health or quality improvement role
• 3+ years' experience in health care or public health with a preferred focus on quality improvement, population health, care management, social work, or behavioral health
• Bachelor's Degree in public health, health administration, social work, or a related field, or equivalent work experience (REQUIRED)

Nice To Haves

• Experience with Improvement methodologies (Six Sigma, Lean, IHI Model)
• Proficient in Microsoft Word, Excel, and PowerPoint
• Embraces change and remains flexible when faced with evolving priorities or ambiguous situations
• Strong analytical, communication, and project management skills
• Self-motivated and demonstrated ability to work independently
• Ability to build collaborative relationships with internal and external stakeholders
• Experience working with Medicaid populations
• Residing in Ohio

Responsibilities

• Using the Institute for Healthcare Improvement model, this individual will lead population health projects to improve health outcomes for the OhioRISE populations.
• Ensure timely management and continual updating of documentation to reflect ongoing changes and outcomes.
• Oversee and drive consistent progress in intervention testing.
• Analyze complex data sets to identify emerging trends and design, test, and evaluate targeted interventions for improvement.
• Serves as a subject matter expert on quality improvement methodologies and tools.
• Deliver presentations to internal and external stakeholders.
• Collaborate with the Ohio Department of Medicaid, Case Western Center of Excellence, Care Management Entities, internal teams and other key stakeholders, including Medicaid managed care plans, community organizations, members/families, and healthcare providers, to develop and implement population health strategies and interventions.
• Support quality improvement initiatives as needed.
• Provides necessary updates as needed and supporting documents for state RFP, NCQA and EQRO reviews and proposal submissions.
• Assisting in ensuring the Plan meets all regulatory requirements as outlined in the Provider Agreement and other accrediting agencies policies.
• Under the direction of the Director of Population Health, develops the annual Population Health Strategy, including assessments on enrollee participation and program impact.
• Ability to travel up to 10% of the time in Ohio to office and state meetings. Must have reliable transportation. Valid/active driver's license, and proof of vehicle insurance.
• Performs additional responsibilities and tasks as required to support team and organizational objectives.

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all 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

What This Job Offers

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