Transition of Care Sr. Clinical Strategist - Aetna Better Health of Oklahoma

CVS Health•Oklahoma City, OK

6d•$78,331 - $168,714•Hybrid

About The Position

The Transition of Care Sr. Clinical Strategist provides enterprise-level leadership for Oklahoma’s Transitions of Care (TOC) program—setting strategy, governance, and performance expectations to reduce avoidable utilization, improve outcomes, and strengthen transitions across the continuum. This role designs and scales TOC models (including 48-hour post-discharge outreach standards and follow-up cadence) and leads the development of standard operating procedures, workflows, and care pathways assuring alignment with state contracts, CMS guidance, and regulatory requirements. This is a hybrid role; candidates must reside within 45–60 minutes of Oklahoma City and be available to work onsite one day per week.

Requirements

Resident of Oklahoma with 45-60 minutes of OKC and an ability to work at least 1x per week onsite.
Active unrestricted RN license in the state of Oklahoma
8 years in healthcare with deep experience in care management, transition of care programs, utilization management, or population health
5+ years leadership experience (direct or matrixed)
Proven experience in Medicaid, Medicare, or commercial plans
2+ years project management experience
2+ years of data-driven decision making and member outcomes metrics
Proficiency with personal computer, keyboard navigation, and MS Office Suite applications (Teams, Outlook, Word, Excel, SharePoint, etc.)

Nice To Haves

Knowledge and understanding of the state Medicaid managed care market, regulations, practices, and integrated health system strongly preferred
Certification in Case Management (CCM) or Quality (CPHQ) preferred

Responsibilities

Provides leadership and oversight for Transitions of Care (TOC) program operations for complex populations by defining standards and performance expectations for integrated behavioral health, physical health, and social service coordination across care settings, consistent with contract requirements.
Serves as the accountable owner for Transition of Care program compliance, ensuring the organization can demonstrate adherence to contractual, regulatory, and policy requirements during audits, State reviews, Joint Operating Committees (JOC), and governing body forums.
Establishes and maintains program standards, workflows, documentation requirements, and escalation pathways for high-risk transitions (e.g., inpatient discharge and plan-to-plan movement), and ensures operational teams execute consistently.
Acts as a senior liaison between community providers and health plan leadership, including State, County, and community agencies, to align TOC requirements, clarify roles, and enable provider and internal teams with program guidance, tools, and standardized pathways.
Interacts with clinical and senior leaders to discuss TOC program performance, compliance risks, system gaps, and strategic priorities.
Partners with cross-functional leaders (e.g., Utilization Management, Care Management, Behavioral Health, Engagement Hub) to operationalize required TOC processes, define escalation models, and ensure readiness for complex transitions (e.g., court-ordered treatment, guardianship, specialized behavioral health services).
Leads standardization and oversight of integrated behavioral and physical health TOC practices, ensuring consistent coordination expectations across primary care, interdisciplinary teams, and downstream providers.
Collaborates with Provider Services and Network teams in monitoring provider network compliance with state and contractual requirements and identifying gaps or opportunities impacting Transitions of Care delivery.
Identifies areas of concern related to TOC program administration, workflows, reporting, dashboards, or alert processes and partners with operational leaders to develop and implement corrective actions and mitigation strategies.
Provides oversight of TOC-related initiatives, pilots, and special projects to ensure alignment with contract requirements, operational readiness, and intended outcomes.
Participates in and supports training and re-education of staff and providers related to TOC expectations, workflows, escalation models, and integrated care practices, reinforcing role clarity and accountability.
Facilitate effective interactions with network and community service providers through provider education focused on transitions of care, integrated behavioral and physical health needs, social service coordination, and appropriate utilization.
Serves as a key leader for the Transitions of Care program, partnering with State agencies, local stakeholders, and the provider network to establish program expectations, accountability, and consistent execution of transitions standards across care settings.
Facilitates system-level change through continued engagement, education, and alignment of stakeholders toward standardized TOC processes and shared accountability models.
Partners with community programs and providers to identify gaps and opportunities for complex-population transitions, and to support implementation of standardized TOC pathways, referral agreements, and coordination protocols at the system level.
Consults with community providers and care management leadership to share best practices and drive adoption of integrated TOC standards across physical and behavioral health, including workflow design, documentation expectations, and escalation models.
Monitors Transitions of Care program performance to ensure adherence to required processes, timelines, and documentation, and identifies training or operational needs to reduce compliance risk.
Under the guidance of the Integrated Care Management Director, supports development and execution of a TOC strategic plan, including objectives, reporting requirements, intended outcomes, and evidence of results aligned to specific contract expectations.
Engages internal partners (Provider Relations, Network Management, Behavioral Health, Care Management, Community Development) to align operating models, roles, and performance expectations that enable consistent, integrated Transitions of Care delivery.
Participates in local, regional, and state meetings with providers, community stakeholders, and State entities, representing the TOC program and reinforcing program accountability, compliance, and measurable improvement in transitions outcomes.
Establishes and maintains a positive and credible organizational presence within the community, including regulators, providers, advocacy groups, and community organizations.
Establishes and maintains ongoing relationships with key agencies, providers, physicians, hospitals, advocacy groups, community organizations, contractual stakeholders, and State officials to support continuity of care and system collaboration.